Skip to main content

Advertisement

SpringerLink
Log in

Long-term Remission of Type 2 Diabetes and Patient Survival After Biliopancreatic Diversion with Duodenal Switch

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Purpose

This study investigates the long-term effects of biliopancreatic diversion with duodenal switch (BPD-DS) on patients with advanced type 2 diabetes mellitus (T2DM) while paying special attention to preoperative diabetes severity.

Materials and Methods

A retrospective analysis was conducted using prospective and current data on patients who underwent an open BPD-DS 6–12 years ago. Patients were stratified according to preoperative diabetes severity into 4 groups (group 1: oral antidiabetic drugs only; group 2: insulin < 5 years; group 3: insulin 5–10 years; group 4: insulin > 10 years). The primary endpoint was T2DM remission rate 6–12 years after BPD-DS as a function of preoperative diabetes severity.

Results

Ninety-one patients with advanced T2DM were included. Sixty-two patients were available for follow-up (rate of 77%). Follow-up was performed (mean ± SD) 8.9 ± 1.3 years after surgery. Glycated hemoglobin (HbA1c) levels were 9.4 ± 2.0% before surgery and decreased to 5.1 ± 0.8% after 1 year and 5.4 ± 1.0% after 6–12 years. Insulin discontinuation rate after surgery as well as the rate of long-term remission decreased steadily from groups 1 to 4, while long-term mortality increased. T2DM remission rates were 93%, 88%, 45%, and 40% in groups 1, 2, 3, and 4, respectively. Late relapse of T2DM occurred in 3 patients (5%).

Conclusions

BPD-DS causes a rapid and long-lasting normalization of glycemic metabolism in patients with advanced T2DM. T2DM remission rate after 6–12 years varies significantly (from 40% to more than 90%) and is highly dependent on preoperative diabetes severity.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Nathan DM. Diabetes: advances in diagnosis and treatment. JAMA. 2015;314:1052–62.

    Article  CAS  Google Scholar 

  2. Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2009;32:193–203.

    Article  CAS  Google Scholar 

  3. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.

    Article  CAS  Google Scholar 

  4. American Diabetes Association. Standards of medical care in diabetes–2009. Diabetes Care. 2009;32(Suppl 1):S13–261.

    Article  Google Scholar 

  5. Rubino F, Schauer PR, Kaplan LM, et al. Metabolic surgery to treat type 2 diabetes: clinical outcomes and mechanisms of action. Annu Rev Med. 2010;61:393–411.

    Article  CAS  Google Scholar 

  6. Friedman MN, Sancetta AJ, Magovern GJ. The amelioration of diabetes mellitus following subtotal gastrectomy. Surg Gynecol Obstet; 1955;100(2):201–4.

  7. Angervall L, Dotevall G, Tillander H. Amelioration of diabetes mellitus following gastric resection. Acta Med Scand 1961;169:743–8.

  8. 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;222:339–50 (discussion 350–22).

    Article  CAS  Google Scholar 

  9. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.

    Article  CAS  Google Scholar 

  10. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–2256.e5.

    Article  Google Scholar 

  11. Scopinaro N, Gianetta E, Civalleri D, et al. Bilio-pancreatic bypass for obesity: II. Initial experience in man. Br J Surg. 1979;66:618–20.

    Article  CAS  Google Scholar 

  12. Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg. 1998;8:267–82.

    Article  CAS  Google Scholar 

  13. Marceau P, Hould FS, Simard S, et al. Biliopancreatic diversion with duodenal switch. World J Surg. 1998;22:947–54.

    Article  CAS  Google Scholar 

  14. Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238:467–84 (discussion 84–25).

    Article  Google Scholar 

  15. Kapeluto JE, Tchernof A, Masckauchan D, et al. Ten-year remission rates in insulin-treated type 2 diabetes after biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis. 2020;16:1701–12.

    Article  Google Scholar 

  16. Frenken M, Cho EY. Metabolic intestinal bypass surgery for type 2 diabetes in patients with a BMI <35 kg/m2: comparative analysis of 16 patients undergoing either BPD, BPD-DS, or RYGB. Obes Facts. 2011;4 Suppl 1(Suppl 1):13–7.

    Article  Google Scholar 

  17. American Diabetes Association. Standards of medical care in diabetes–2008. Diabetes Care. 2008 Jan;31(Suppl 1):S12–254.

    Article  Google Scholar 

  18. Cho EY, Kemmet O, Frenken M. Biliopancreatic diversion with duodenal switch in patients with type 2 diabetes mellitus: is the chance of complete remission dependent on therapy and duration of insulin treatment? Obes Facts. 2011;4 Suppl 1(Suppl 1):18–23.

    Article  Google Scholar 

  19. Brethauer SA, Kim J, el Chaar M, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11:489–506.

    Article  Google Scholar 

  20. Aminian A, Zajichek A, Arterburn DE et al. Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity. JAMA 2019;322(13):1271–282.

  21. Aminian A, Zajichek A, Arterburn DE, et al. Predicting 10-year risk of end-organ complications of type 2 diabetes with and without metabolic surgery: a machine learning approach. Diabetes Care. 2020;43:852–9.

    Article  CAS  Google Scholar 

  22. Renquist K, Jeng G, Mason EE. Calculating follow-up rates. Obes Surg. 1992;2(4):361–7.

    Article  CAS  Google Scholar 

  23. Gastrointestinal surgery for severe obesity. Proceedings of a National Institutes of Health Consensus Development Conference. Am J Clin Nutr. 1992:615S–2619S.

  24. Bolckmans R, Himpens J. Long-term (10 yrs) outcome of the laparoscopic biliopancreatic diversion with duodenal switch. Ann Surg. 2016;264:1029–37.

    Article  Google Scholar 

  25. DeMaria EJ, Portenier D, Wolfe L. Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Relat Dis. 2007;3:134–40.

    Article  Google Scholar 

  26. Polonsky KS, Given BD, Hirsch L, et al. Quantitative study of insulin secretion and clearance in normal and obese subjects. J Clin Invest. 1988;81:435–41.

    Article  CAS  Google Scholar 

  27. Nyholm B, Walker M, Gravholt CH, et al. Twenty-four-hour insulin secretion rates, circulating concentrations of fuel substrates and gut incretin hormones in healthy offspring of type II (non-insulin-dependent) diabetic parents: evidence of several aberrations. Diabetologia. 1999;42:1314–23.

    Article  CAS  Google Scholar 

  28. Mingrone G, Castagneto M. Bariatric surgery: unstressing or boosting the beta-cell? Diabetes Obes Metab. 2009;11(Suppl 4):130–42.

    Article  CAS  Google Scholar 

  29. Harris L-A, Kayser BD, Cefalo C, et al. Biliopancreatic diversion induces greater metabolic improvement than Roux-en-Y gastric bypass. Cell Metab. 2019;30:855–2864.e3.

    Article  CAS  Google Scholar 

  30. Frenken M, Cho EY, Karcz WK, et al. Improvement of type 2 diabetes mellitus in obese and non-obese patients after the duodenal switch operation. J Obes. 2011;2011: 860169.

    Article  CAS  Google Scholar 

  31. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–9.

    Article  CAS  Google Scholar 

  32. Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care. 2004;27:1487–95.

    Article  Google Scholar 

Download references

Author information

Author notes

  1. The authors Michael Frenken and Olga Kemmet have contributed equally to this work

Authors and Affiliations

  1. Department of General and Visceral Surgery, Center of Metabolic Surgery, Hospital zum Heiligen Geist, Lange Str. 4-6, 60311, Frankfurt, Germany

    Michael Frenken

  2. Marien Hospital Herne, Department of Urology, Center of Uro-Oncology, Ruhr University of Bochum, Hölkeskampring 40, 44625, Herne, Germany

    Olga Kemmet

  3. Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany

    Miriam Frenken

  4. Diabetes Center Rheinland, St. Josef Hospital Haan, Robert-Koch-Straße 16, 42781, Haan, Germany

    Ingo Röhrig

  5. Department of General and Visceral Surgery, Klinikum Mittelbaden Baden-Baden Bühl, Robert-Koch-Str. 70, 77815, Bühl, Germany

    Lars Fischer

  6. Department of General, Visceral, Endocrine and Oncologic Surgery, Clinic of Fulda, Campus Fulda – University of Marburg, Pacelliallee 4, 36043, Fulda, Germany

    Achim Hellinger

Authors
  1. Michael Frenken
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Olga Kemmet
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miriam Frenken
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ingo Röhrig
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lars Fischer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Achim Hellinger
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design: Michael Frenken, Olga Kemmet, Miriam Frenken, Ingo Röhrig, Lars Fischer, Achim Hellinger.

Acquisition of data: Michael Frenken, Olga Kemmet.

Analysis and interpretation of data: Michael Frenken, Olga Kemmet.

Drafting of manuscript: Michael Frenken, Olga Kemmet.

Critical revision: Michael Frenken, Olga Kemmet, Miriam Frenken, Ingo Röhrig, Lars Fischer, Achim Hellinger.

Corresponding author

Correspondence to Michael Frenken.

Ethics declarations

Ethical Approval

All procedures performed in studies involving human participants were done so in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For the retrospective part of the study, formal consent was not required.

Consent to Participate

Informed consent was obtained from all participants in the study who participated in the last follow-up.

Conflict of Interest

The authors declare no competing interests.

Confirmation of STROBE Statement

The present study complies with each item on the STROBE checklist.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Key Points

• Patients with advanced T2DM were analyzed 6–12 years after BPD-DS.

• Overall, complete T2DM remission rate was 71% with an improvement rate of 23%.

• Remission rate, absence of insulin, and mortality were dependent on T2DM severity.

• BPD-DS offers favorable outcomes for patients with moderate to severe T2DM.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Frenken, M., Kemmet, O., Frenken, M. et al. Long-term Remission of Type 2 Diabetes and Patient Survival After Biliopancreatic Diversion with Duodenal Switch. OBES SURG 32, 3340–3350 (2022). https://doi.org/10.1007/s11695-022-06223-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-022-06223-5

Keywords

Search

Navigation