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

Abstract

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. A retrospective analysis was conducted using prospective and current data on patients who underwent an open BPD-DS 6-12years ago. Patients were stratified according to preoperative diabetes severity into 4 groups (group 1: oral antidiabetic drugs only; group 2: insulin < 5years; group 3: insulin 5-10years; group 4: insulin > 10years). The primary endpoint was T2DM remission rate 6-12years after BPD-DS as a function of preoperative diabetes severity. 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 ± 1.3years after surgery. Glycated hemoglobin (HbA1c) levels were 9.4 ± 2.0% before surgery and decreased to 5.1 ± 0.8% after 1year and 5.4 ± 1.0% after 6-12years. 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%). BPD-DS causes a rapid and long-lasting normalization of glycemic metabolism in patients with advanced T2DM. T2DM remission rate after 6-12years varies significantly (from 40% to more than 90%) and is highly dependent on preoperative diabetes severity.