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Improvement of Insulin Resistance and Reduction of Cardiovascular Risk Among Obese Patients with Type 2 Diabetes with the Duodenojejunal Bypass Liner

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Abstract

Background

This study aims to evaluate the effectiveness of the duodenojejunal bypass liner (DJBL) in the improvement of insulin resistance and reduction of cardiovascular risk among morbidly obese patients with type 2 diabetes mellitus, using the triglyceride/high-density lipoprotein (HDL) cholesterol ratio, percentage of weight loss, and glycemic control.

Methods

We used the TG/HDL ratio with a cutoff value of 3.5 to identify patients with insulin resistance. The value of the initial ratio was compared with the ratio obtained 6 months after implantation to evaluate whether an improvement in insulin resistance occurred. We also evaluated the improvement of glycated hemoglobin levels and the weight loss resulted from the use of the device and correlated that with the improvement of the TG/HDL ratio.

Results

All patients implanted with the device presented a statistically significant reduction of the HbA1c levels, with most patients (70.3%) obtaining diabetes control with HbA1c levels lower than 7% at the end of the study. All patients also presented a significant weight reduction, with an average loss of 12.6% of their initial weight. We observed an important improvement in insulin resistance and metabolic syndrome, with a significant reduction of the TG/HDL ratio from 5.75 to 4.36 (p < 0.001) and 42.6% of the patients presenting a TG/HDL ratio lower than 3.5 at the end of the study.

Conclusions

The DJBL, when used for a period of 6 months, is effective in the control of diabetes, weight loss, improvement of insulin resistance, and decrease of cardiovascular risk among morbidly obese patients with type 2 diabetes mellitus.

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Conflict of Interest

Galvão-Neto M.P. and Ramos A.C. are independent consultants of GI dynamics (device designer company). The other authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 255—Cerqueira César, 05403-000, São Paulo, Brazil

    Eduardo Guimarães Hourneaux de Moura, Ivan Roberto Bonotto Orso, Bruno da Costa Martins, Guilherme Sauniti Lopes, Suzana Lopes de Oliveira & Paulo Sakai

  2. Gastro Obeso Center, São Paulo, Brazil

    Manoel dos Passos Galvão-Neto & Almino Cardoso Ramos

  3. Endocrinology and Metabolic Department, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil

    Marcio Correa Mancini & Alfredo Halpern

  4. Division of Digestive Surgery, Gastroenterology Department, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil

    Marco Aurélio Santo, Arthur Belarmino Garrido-Júnior & Ivan Cecconello

Authors
  1. Eduardo Guimarães Hourneaux de Moura
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  2. Ivan Roberto Bonotto Orso
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  3. Bruno da Costa Martins
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  4. Guilherme Sauniti Lopes
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  5. Suzana Lopes de Oliveira
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  6. Manoel dos Passos Galvão-Neto
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  7. Marcio Correa Mancini
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  8. Marco Aurélio Santo
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  9. Paulo Sakai
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  10. Almino Cardoso Ramos
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  11. Arthur Belarmino Garrido-Júnior
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  12. Alfredo Halpern
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  13. Ivan Cecconello
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Corresponding author

Correspondence to Eduardo Guimarães Hourneaux de Moura.

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de Moura, E.G.H., Orso, I.R.B., Martins, B. et al. Improvement of Insulin Resistance and Reduction of Cardiovascular Risk Among Obese Patients with Type 2 Diabetes with the Duodenojejunal Bypass Liner. OBES SURG 21, 941–947 (2011). https://doi.org/10.1007/s11695-011-0387-0

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  • DOI: https://doi.org/10.1007/s11695-011-0387-0

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