title: Remission of type 2 diabetes in patients undergoing biliointestinal bypass for morbid obesity: a new surgical treatment.
abstract: BACKGROUND
  Nutrient interaction with the mid-gut may play a role in improving type 2 diabetes mellitus (T2D) after bariatric surgery. However, Roux-en-Y gastric bypass, biliopancreatic diversion, and sleeve gastrectomy include diversion of food from the duodenum and/or partial gastrectomy. Biliointestinal bypass (BIBP) was introduced to eliminate the major side effects of jejunoileal bypass. It does not involve any change to the anatomy of the stomach or the duodenum. A prospective evaluation of the role of BIBP in glycemic control has not been reported.
  
  
  OBJECTIVE
  Longitudinal evaluation of T2D after BIBP.
  
  
  METHODS
  University hospitals in Europe and Canada.
  
  
  METHODS
  The effects of BIBP on metabolism and glycemia in 28 consecutive patients with T2D were evaluated over 2 years.
  
  
  RESULTS
  Decreases (P<.001) in fasting glycemia, insulinemia, and homeostasis model assessment were observed 3 months after surgery, were improved after 1 year, and remained stable after 2 years. Glycosylated hemoglobin levels decreased at 3, 12, and 24 months after surgery (from 9.2±2.1 to 6.3±1.1 (P<.0001), 4.9±1.7 (P<.0001), and 4.8±1.1 (P<.0001), after 3, 12, and 24 months, respectively). Medical therapy was discontinued in 83% (20 of 24) of the patients; for the remaining 17% (4 of 24), therapy was reduced to oral hypoglycemic agents.
  
  
  CONCLUSIONS
  BIBP had a favorable risk-benefit relationship and positive metabolic effects in the short term. How BIBP achieves optimal glycemic control and whether it improves β-cell function and/or insulin sensitivity require further study.
authors.affiliation: Division of General and Bariatric Surgery, Second University of Naples, Naples, Italy. Electronic address: gianmattia.delgenio@unina2.it.
authors.forename: Gianmattia
authors.initials: G
authors.lastname: Del Genio
authors.affiliation: Department of Surgery, Hopital Du Sacre Coeur, Montreal, QC, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Gagner
authors.affiliation: Division of General and Bariatric Surgery, Second University of Naples, Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Limongelli
authors.affiliation: Division of General and Bariatric Surgery, Second University of Naples, Naples, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tolone
authors.affiliation: Investigative Science, Imperial College London, London, UK.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Pournaras
authors.affiliation: Investigative Science, Imperial College London, London, UK; Diabetes Complications Research Centre, UCD Conway Institute, University College Dublin, Dublin, Ireland.
authors.forename: Carel W
authors.initials: CW
authors.lastname: le Roux
authors.affiliation: Division of General and Bariatric Surgery, Second University of Naples, Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Brusciano
authors.affiliation: Division of General and Bariatric Surgery, Second University of Naples, Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Licia Mozzillo
authors.affiliation: Center of Esophago-gastric and Bariatric Surgery (E.G.O.), Clinica C.G. Ruesch(,) Naples, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Del Genio
authors.affiliation: Division of General and Bariatric Surgery, Second University of Naples, Naples, Italy.
authors.forename: Ludovico
authors.initials: L
authors.lastname: Docimo
mesh_terms: D000328:Adult; D015904:Biliopancreatic Diversion / Q000379:methods*; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D007328:Insulin / Q000378:metabolism; D050417:Insulin-Secreting Cells / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000378:metabolism / Q000601:surgery*; D011446:Prospective Studies; D012074:Remission Induction; D012709:Serum Albumin / Q000378:metabolism; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; D012709:Serum Albumin
keywords: Bariatric surgery; Biliointestinal bypass; Metabolic surgery; T2D; Type 2 diabetes