Early remission of type 2 diabetes mellitus by laparoscopic ileal transposition with sleeve gastrectomy surgery in 23–35 BMI patients

Abstract

To assess the efficacy of ileal transposition with sleeve gastrectomy (SGIT) surgery in remission of Type 2 Diabetes Mellitus (T2DM) in patients with 23–35 BMI. Diabetes is considered a life style disease. Despite medications and lifestyle changes, (HbA1c) - remains > 7 in 56 % of diabetics, predisposing them to high risk of diabetes related complications. Bariatric surgery results in remission of diabetes in over 84% patients with BMI > 35 m2s/m2. Based on hindgut hypothesis suggesting role of incretins like GLP-1, early trials of ileal interposition surgery have displayed consistent HbA1c levels below 7 in over 80% patients with BMI > 30 m2/m2. In developing countries majority of T2DM patients are not morbidly obese and surgical procedures are to be evaluated for their efficacy in this group. In this study we have assessed the efficacy of ileal transposition with sleeve gastrectomy (SGIT) in 23–35 BMI T2DM patients. Selected T2DM patients [HbA1c > 7, C Peptide > -1 ng/ml] underwent Lap SGIT by a single surgeon. Data of first five patients with minimum 6 months follow up was analyzed for glycemic control and altered need for medications. Data were analyzed using SPSS (SPSS release 16; SPSS Inc. Chicago). The study target (HbA1c < 7) was achieved in 60% of patients within 1 month and in 100% of patients within 6 months. Requirement of medications reduced significantly within 6 months and their HbA1c levels reduced from 9.65% to 6.22%. Laparoscopic SGIT may represent a new paradigm for the treatment of T2DM even in non morbidly obese patients.