Surgery for Nonobese Type 2 Diabetic Patients: An Interventional Study with Duodenal–Jejunal Exclusion
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A 24-week interventional prospective trial was performed to compare the benefits of open duodenal–jejunal exclusion surgery (GJB) with a matched control group on standard medical care.
One-hundred eighty patients were screened for the surgical approach. Twelve patients accepted to be operated and presented the full eligibility criteria for surgery that includes overweight BMI (25–29.9 kg/m2), T2DM diagnosis for less than 15 years, insulin-treated patients, no history of major complications, preserved beta-cell function, and absence of autoimmunity. A matched control group (CG) of patients whom refused surgical treatment was placed to receive standard care. Patients had age of 50 (5) years, time of diagnosis 9 years (range, 3 to 15 years), time of insulin usage 6 months (range, 3 to 48 months), fasting glucose (FG), 9.8 (2.5) mg/dL, and glycated hemoglobin (A1C) 8.90 (2.12)%.
At 24 weeks after surgery, patients experienced greater reductions on FG (14% vs. 7% on CG), A1C (from 8.78 to 7.84 in GJB—p < 0.01 and 8.93 to 8.71 in CG; p < 0.05 between groups) and reductions on average daily insulin requirement (93% vs. 29%, p < 0.01). Ten patients stopped insulin usage in GJB but they remain taking oral medications. No differences were observed in both groups regarding BMI, body distribution and composition, blood pressure, and lipids.
In conclusion, duodenal–jejunal exclusion was an effective treatment for nonobese T2DM subjects. GJB was superior to standard care in achieving better glycemic control along with reduction in insulin requirements.
KeywordsMetabolic surgery Type 2 diabetes Insulin therapy Incretin Insulin resistance Duodenal–jejunal exclusion Diabetes surgery
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