Obesity Surgery

, Volume 17, Issue 2, pp 185–192 | Cite as

Long-Term Control of Type 2 Diabetes Mellitus and the Other Major Components of the Metabolic Syndrome after Biliopancreatic Diversion in Patients with BMI <35 kg/m2

  • Nicola Scopinaro
  • Francesco Papadia
  • Giuseppe Marinari
  • Giovanni Camerini
  • Gianfranco Adami


Bariatric operations are the most powerful means of curing type 2 diabetes mellitus (T2D) and the other major components of the metabolic syndrome. Despite the very frequent occurrence of metabolic disturbances in patients with BMI from 30 to 35, there is a general reluctance to operate on these patients, as their disease is considered less severe.


7 T2D obese patients with mean BMI <35 underwent BPD between 1976 and 1996 at the Azienda Ospedaliera Universitaria San Martino of Genoa, Italy. Mean age was 49 years, mean body weight 91 kg, and mean waist circumference 115 (M) and 98 (F) cm. The mean follow-up was 13 (10–18) years. All 7 patients had abnormally high values of serum triglyceride, serum cholesterol, and arterial pressure.


In all patients, serum glucose was normalized at 1, 2, and 3 years. In 5 patients, a slight increase of serum glucose above 125 mg/dl was observed at or around 5 years, the values being maintained at all subsequent times, with no one value higher than 160 mg ever being recorded. The other 2 patients showed full resolution of diabetes at all follow-up times. Both serum cholesterol and triglyceride values fell to normal 1 year after BPD, and remained within the normal range in all 7 patients during the entire follow-up observation. Arterial pressure normalized in 6 cases and was improved in I case. No patient had excessive weight loss at any postoperative time.


T2D patients with BMI <35 have very severe metabolic disturbances. Surgical therapy for these patients is warranted, and it should be performed as soon as possible, before the rapid evolution of the pattern leads them to a point where even the most effective metabolic surgery operation could be insufficient to yield complete and permanent control of their diabetes.

Key words

Obesity obesity surgery biliopancreatic diversion type 2 diabetes metabolic syndrome 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Richardson DW, Vinik AI. Metabolic implications of obesity: before and after gastric bypass. Gastroenterol Clin North Am 2005; 34: 9–24.PubMedCrossRefGoogle Scholar
  2. 2.
    Silvestre V, Ruano M, Dominguez Y et al. Morbid obesity and gastric bypass surgery: biochemical profile. Obes Surg 2004; 14: 1227–32.PubMedCrossRefGoogle Scholar
  3. 3.
    Sjostrom L, Lindroos AK, Peltonen M et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004; 351: 2683–93.PubMedCrossRefGoogle Scholar
  4. 4.
    Pories WJ, Swanson MS, MacDonald KG et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 1995; 222: 339–52.PubMedCrossRefGoogle Scholar
  5. 5.
    MacDonald KG Jr, Long SD, Swanson MS et al. The gastric bypass operation reduces the progression and mortality of non-insulin-dependent diabetes mellitus. J Gastrointest Surg 1997; 1: 213–20.PubMedCrossRefGoogle Scholar
  6. 6.
    Scopinaro N, Marinari GM, Camerini G et al. Specific effects of biliopancreatic diversion on the major components of metabolic syndrome: a long-term followup study. Diabetes Care 2005; 28: 2406–11.PubMedCrossRefGoogle Scholar
  7. 7.
    Lapidus L, Bengtsson C, Larsson B et al. Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden. Br Med J 1984; 289: 1257–61.Google Scholar
  8. 8.
    Larsson B, Svardsudd K, Welin L et al. Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. Br Med J 1984; 288:1401–4.CrossRefGoogle Scholar
  9. 9.
    IFSO Statement on Patient Selection for Bariatric Surgery. Obes Surg 1997; 7:41.Google Scholar
  10. 10.
    Angrisani L, Favretti F, Furbetta F et al. Italian Group for Lap-Band System: results of multicenter study on patients with BMI ≤35 kg/m2. Obes Surg 2004; 14: 415–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Cossu ML, Noya G, Tonolo GC et al. Duodenal switch without gastric resection: results and observations after 6 years. Obes Surg 2004; 14:1354–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Cohen R, Pinheiro JS, Correa JL et al. Laparoscopic Roux-en-Y gastric bypass for BMI <35 kg/m2: a tailored approach. SOARD 2006; 2: 401–4.Google Scholar
  13. 13.
    Prentki M, Nolan CJ. Islet beta cell failure in type 2 diabetes. J Clin Invest 2006; 116: 1802–12.PubMedCrossRefGoogle Scholar
  14. 14.
    Guidone C, Manco M, Valera-Mora E et al. Mechanisms of recovery from type 2 diabetes after malabsorptive bariatric surgery. Diabetes 2006; 55: 2025–31.PubMedCrossRefGoogle Scholar
  15. 15.
    Greco AV, Mingrone G, Giancaterini A et al. Insulin resistance in morbid obesity: reversal with intramyocellular fat depletion. Diabetes 2002; 51: 144–51.PubMedCrossRefGoogle Scholar
  16. 16.
    Adami GF, Parodi RC, Papadia F et al. Magnetic resonance spectroscopy facilitates assessment of intramyocellular lipid changes: a preliminary shortterm study following biliopancreatic diversion. Obes Surg 2005; 15: 1233–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Scopinaro N, Marinari GM, Pretolesi F et al. Energy and nitrogen absorption after biliopancreatic diversion. Obes Surg 2000;10: 436–41.PubMedCrossRefGoogle Scholar
  18. 18.
    Scopinaro N. Biliopancreatic diversion: mechanisms of action and long-term results. Obes Surg 2006; 16: 683–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Nicola Scopinaro
    • 1
    • 2
  • Francesco Papadia
    • 1
  • Giuseppe Marinari
    • 1
  • Giovanni Camerini
    • 1
  • Gianfranco Adami
    • 1
  1. 1.Department of SurgeryUniversity of Genoa Medical School, Azienda Ospedaliera Universitaria San MartinoGenoaItaly
  2. 2.Dipartimento di Chirurgia, U.O. Clinica di Chirurgia Generale, Funzionale e MetabolicaAzienda Ospedaliera Universitaria San MartinoGenovaItaly

Personalised recommendations