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Modified sleeve gastrectomy can treat type 2 diabetes

NEW YORK (Reuters Health) – Modified sleeve gastrectomy may improve type 2 diabetes and even trigger remission, new research has found. And the benefits, apparently, are not limited to obese patients, researchers said June 26 at the Endocrine Society’s annual meeting in Houston, Texas.

“Modified bariatric surgery promises to be an effective treatment for achieving a cure of Type 2 diabetes and other metabolic abnormalities like high blood pressure,” Dr. Kirtikumar Modi, an endocrinologist who led the research at Medwin Hospital in Hyderabad, India, said in a statement.

Dr. Modi did not respond to a request by Reuters Health for comment. The statement, however, advises physicians to consider the surgery at an earlier stage of type 2 diabetes, and not as a last resort.

The study had two parts. In the first, 43 patients with poorly controlled diabetes underwent sleeve gastrectomy and an ileal interposition.

Their average duration of diabetes was 10.1 years, and the average body mass index was 33.2kg/m2. Thirty patients had hypertension, 20 had dyslipidemia, and 18 had microalbuminuria.

During postoperative follow-up for an average of 20 months, the researchers saw remission in 20 patients, a significant decrease in the need for oral hypoglycemic agents, and a statistically significant improvement in glycemic parameters.

Also, hypertension resolved in 27 patients.

Certain patients saw greater benefits. Those who had diabetes for less than 10 years, those with a stimulated C-peptide greater than 4 ng/ml, and those who were more overweight with a BMI greater than 27 kg/m2.

In fact, when Dr. Modi excluded the patients who were not obese, the remission rate rose from 47% to 85%.

In the second part of the study, 17 patients who had diabetes for longer, on average, than those in the first phase (i.e., 15 years), underwent a diverted sleeve gastrectomy, as well as an ileal interposition. The procedure diverts food from the duodenum.

The mean BMI in this group was 29.2kg/m2. Eight had hypertension.

After a mean of nine months, Dr. Modi’s team found that 12 patients (70.5%) had remission. The other five improved significantly, and hypertension resolved in seven patients.

The surgery’s effects may be two-fold, Dr. Modi’s team says. The sleeve restricts calories absorbed and reduces ghrelin (the so-called “hunger hormone”), and the ileal interposition causes foods to stimulate the ileum, which enhances GLP-1 secretion.

“This study builds upon the knowledge that we have gained over the past 10 years on bariatric surgery procedures and the mechanisms of weight loss and remission of type 2 diabetes,” Dr. Caroline Apovian, who directs the Nutrition and Weight Management Center at Boston Medical Center, told Reuters Health.

She said, “Specifically, there are several pathways by which appetite and satiety are regulated, some of which involve ghrelin, and GLP-1 secretion from the gut. This series shows that combining two procedures can enhance weight loss and diabetes remission by affecting more than one pathway. More study should lead to development of new procedures for weight loss and type II DM remission.”