title: Laparoscopic ileal interposition with diverted sleeve gastrectomy for treatment of type 2 diabetes.
abstract: OBJECTIVE
  The objective of the present study was to prospectively evaluate the results of laparoscopic ileal interposition (II) with diverted sleeve gastrectomy (DSG) for control of T2DM and related metabolic abnormalities.
  
  
  METHODS
  All patients underwent II +DSG. They had T2DM≥5 years with poor glycemic control despite adequate dosage of oral hypoglycemic agents (OHAs) and/or insulin. The primary outcome was remission of diabetes (HbA1C<6.5% without OHAs/insulin), and secondary outcomes were reduction in antidiabetic agent requirement and components of metabolic syndrome.
  
  
  RESULTS
  We report the preliminary postoperative follow-up data of 9.1±5.3 months (range: 3-21 months). There were 17 patients (male:female=12:5) with mean age of 50.7±8.1 (range, 34-66 years), duration of diabetes of 15.1±5.8 years (range, 5-30 years), and preoperative body mass index of 29.2±7.5 kg/m(2)(range, 22.4-37.5 kg/m(2)). Eight patients (45%) had hypertension, while dyslipidemia and microalbuminuria was present in 7 patients (39%) each. Twelve patients (70.5%) had diabetes remission. Seven/eight (87.5%) patients had remission in hypertension. All participants had weight loss ranging between 15% and 30%. Postoperatively statistically significant decline was observed in the glycemic and lipid parameters, microalbuminuria at all intervals (p<0.05). Two patients had vitamin B12 deficiency 1 year after surgery.
  
  
  CONCLUSIONS
  Ileal interposition combined with DSG addresses both foregut and hindgut theories and brings about remissions in T2DM patients with reasonable safety. Our preliminary observations demonstrated the feasibility and efficacy of this novel surgical procedure as a promising option in T2DM.
authors.affiliation: Department of Endocrinology, Medwin Hospital, Hyderabad, Andhra Pradesh, India. hidocsunil@ibibo.com
authors.forename: Sunil Kumar
authors.initials: SK
authors.lastname: Kota
authors.forename: Surendra
authors.initials: S
authors.lastname: Ugale
authors.forename: Neeraj
authors.initials: N
authors.lastname: Gupta
authors.forename: Kirtikumar D
authors.initials: KD
authors.lastname: Modi
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology / Q000601:surgery*; D050171:Dyslipidemias; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007194:India / Q000453:epidemiology; D010535:Laparoscopy; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology / Q000601:surgery*; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D011446:Prospective Studies; D012074:Remission Induction; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human