title: Diverted sleeve gastrectomy with ileal transposition in overweight, obese, and morbidly obese patients with type 2 diabetes: results of 1-year follow-up.
abstract: BACKGROUND
  Bariatric surgery is an effective intervention for morbidly obese individuals, and it normalizes the level of glycemia in the majority of patients with type 2 diabetes mellitus (T2DM).
  
  
  OBJECTIVE
  The primary aim of the study was to examine the efficacy of diverted sleeve gastrectomy with ileal transposition on weight loss and glycemic control in overweight, obese, and morbidly obese T2DM patients. The secondary aim was to examine the relationship between the effect of surgery and body mass index (BMI).
  
  
  METHODS
  Metabolic surgery clinic.
  
  
  METHODS
  This study was performed between October 2011 and August 2014, and mean duration of follow-up was 1 year. A total of 131 patients with T2DM were included. Ileal transposition with sleeve gastrectomy were performed in all patients. Each patient received a standard mixed meal tolerance test; plasma glucose, C-peptide, and insulin concentrations were measured before and 1 hour after the test. Postoperative alterations in BMI were noted.
  
  
  RESULTS
  Mean BMI decreased from 33.1±.5 to 23.5±.2 kg/m(2) at 1 year, with the magnitude of weight loss correlating with baseline weight (P<.0001). There were marked decreases in fasting plasma glucose concentration and mean glycosylated hemoglobin levels at 1 year. Neither the decrease in fasting plasma glucose or glycosylated hemoglobin correlated with the decrease in weight. The homeostasis model assessment index decreased from 9.6±1.2 to 2.2±.2, P<.0001, and the Matsuda index for insulin sensitivity increased from 2.2±.2 to 7.8±.4, P<.0001. Despite the improvement in insulin sensitivity, surgery caused a 4-fold increase in insulin secretion (P<.01).
  
  
  CONCLUSIONS
  Diverted sleeve gastrectomy with ileal transposition is effective in glycemic control in patients with T2DM; however, this was not dependent on preoperative BMI values.
authors.affiliation: Department of General Surgery, Taksim German Hospital Metabolic Surgery Clinic, Istanbul, Turkey. Electronic address: doktoralper@hotmail.com.
authors.forename: Alper
authors.initials: A
authors.lastname: Celik
authors.affiliation: Department of Endocrinology and Metabolism, GATA Haydarpasa Research Hospital, Istanbul, Turkey.
authors.forename: Eylem
authors.initials: E
authors.lastname: Cagiltay
authors.affiliation: Department of Bariatric and Metabolic Surgery, Kirloskar Hospital, Hyderabad, India.
authors.forename: Surendra
authors.initials: S
authors.lastname: Ugale
authors.affiliation: Department of General Surgery, Taksim German Hospital Metabolic Surgery Clinic, Istanbul, Turkey.
authors.forename: Muharrem
authors.initials: M
authors.lastname: Asci
authors.affiliation: Department of General Surgery, Taksim German Hospital Metabolic Surgery Clinic, Istanbul, Turkey.
authors.forename: Bahri Onur
authors.initials: BO
authors.lastname: Celik
authors.affiliation: Department of General Surgery, Taksim German Hospital Metabolic Surgery Clinic, Istanbul, Turkey; Department of General Surgery, Kanuni Research Hospital, Istanbul, Turkey.
authors.forename: Can
authors.initials: C
authors.lastname: Karaca
authors.affiliation: Diabetes Division, University of Texas Health Science Center, San Antonio, Texas; Department of General Surgery, Kanuni Research Hospital, Istanbul, Turkey.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Abdul-Ghani
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D007082:Ileum / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery; D061646:Operative Time; D050177:Overweight / Q000601:surgery*; D011446:Prospective Studies; D055815:Young Adult
keywords: Ileal transposition; Obese; Overweight; Type 2 diabetes