title: Predictors for remission of major components of the metabolic syndrome after biliopancreatic diversion with duodenal switch (BPDDS).
abstract: BACKGROUND
  Metabolic surgery causes the remission of type 2 diabetes mellitus (T2DM), hypertension, and hyperlipidemia to varying degrees, depending on the patient characteristics and the surgical procedure. The aim of this study was to find predictors for the remission of T2DM and hypertension after biliopancreatic diversion with duodenal switch (BPDDS).
  
  
  METHODS
  Eighty patients with T2DM were followed up for 2 years or more after BPDDS, and changes in body weight and metabolic status were noted. Remission was defined as fasting glucose <7 mmol/l with HbA1C <6.5 %, blood pressure <140/90 mmHg, and low-density lipoprotein (LDL) <2.6 mmol without the use of medication.
  
  
  RESULTS
  Preoperatively, the mean age was 44 years, body mass index (BMI) was 48 kg/m(2), and duration of diabetes was 5 years. Of the 80 patients, 38 patients were using insulin, 48 patients were using antihypertensives, and 38 patients were using a lipid-lowering drug. Five percent of the patients had recommended levels for HbA1C, blood pressure, and LDL prior to the operation. The remission rate at 2 years was 94 % for T2DM, 54 % for hypertension, and 86 % for LDL hyperlipidemia. Preoperative predictors for nonremission of T2DM were a higher BMI, insulin usage, and low insulin C-peptide, and for hypertension, older age and more severe hypertension. Postoperative weight loss was important for both.
  
  
  CONCLUSIONS
  Surgical intervention with BPDDS is an effective treatment of T2DM, hypertension, and hyperlipidemia. The duration of T2DM and age of the patient are the most important preoperative predictors for the remission of T2DM and hypertension, respectively.
authors.affiliation: Department of Surgery, Førde Central Hospital, 6807 Førde, Norway. villy.vage@helse-forde.no
authors.forename: Villy
authors.initials: V
authors.lastname: Våge
authors.forename: Roy M
authors.initials: RM
authors.lastname: Nilsen
authors.forename: Arnold
authors.initials: A
authors.lastname: Berstad
authors.forename: Jan
authors.initials: J
authors.lastname: Behme
authors.forename: Nils
authors.initials: N
authors.lastname: Sletteskog
authors.forename: Ronny
authors.initials: R
authors.lastname: Gåsdal
authors.forename: Camilla
authors.initials: C
authors.lastname: Laukeland
authors.forename: Gunnar
authors.initials: G
authors.lastname: Mellgren
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage; D015904:Biliopancreatic Diversion / Q000379:methods; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood; D006973:Hypertension / Q000097:blood; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D000960:Hypolipidemic Agents / Q000008:administration & dosage; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000503:physiopathology / Q000601:surgery*; D011237:Predictive Value of Tests; D012074:Remission Induction / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D000959:Antihypertensive Agents; D001786:Blood Glucose; D002096:C-Peptide; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents