Long-term clinical and functional impact of biliopancreatic diversion on type 2 diabetes in morbidly and non-morbidly obese patients.

Setting: Obesity surgeryhasbeenproposedasatreatmentoptionfordiabeticpatientswithbody mass index(BMI) o 35 kg/m2, buttheefficacy ofmetabolicsurgeryhasnotbeenconclusively determined. Objectives: To evaluatethelong-termmetabolicoutcomeofnon–morbidly obese(NMO)patients with type2diabetes(T2D)afterbiliopancreaticdiversion(BPD). Material andmethods: Two groupsofT2Dpatientswithdifferentdegreeofobesity(NMO,17 cases, BMI25–35 kg/m2; andmorbidlyobese[MO],13cases,BMI 4 35 kg/m2) werestudied before andat1and5yearsafterBPDinauniversityhospitalsetting.Insulinsecretionwasassessed by acuteinsulinresponse(AIR)tointravenousglucoseandbyinsulinogenicindex(IGI). Results: In allMOpatients,T2Dwasremittedorcontrolled(1case)at1yearandresultswere maintained at5years;AIR(μU/mL) andIGI(μU/mg) improved(P o .001) at1year(from.1 3.1 to 18.52 21.9, andfrom6.0 8.5 to9.1 22.8, respectively)withafurtherincrease(to 24.8 25.5 andto14.3 13.8, respectively)at5years.WithintheNMOgroup,T2Dwasremitted in 1/17andcontrolledin14/17patientsat1year,andin2/17andin4/17patientsat5years, respectively; AIR(μU/mL) andIGI(μU/mg) remainedunchangedthroughoutthepostoperative period (from.31 9.26 to1.5 2.8 at1yrandto.4 3.29 at5yrforAIR,andfrom2.2 4.9 to 1.3 9.0 at1yrandto2.3 3.3 at5yrforIGI). Conclusions: After BPD,restorationof β-cell secretion/productionplaysapivotalroleindeter- mining postoperativeT2Dremission.(SurgObesRelatDis2016;12:822–827.) r 2016 American Society forMetabolicandBariatricSurgery.Allrightsreserved.