Biliopancreatic diversion shows better biochemical results than conventional therapy in Obese T2DM patients
Some studies have shown that metabolic/bariatric surgery is far more efficient than the traditional pharmacological conservative therapies in achieving and maintaining glycemic control among type 2 diabetic (T2DM) severely obese patients.
However, a recent study suggests biliopancreatic diversion (BPD) should be used with caution as a metabolic procedure in the treatment of T2DM in overweight or class 1 obese patients. The study findings were published in the journal Obesity Surgery on January 10, 2022.1
Previous studies demonstrate that in class 1 obese and overweight patients, bariatric/metabolic surgery is followed by a T2DM remission or by a noticeable improvement of glucose control in a significant number of operated subjects, the results being overall better than those observed in T2DM individuals treated by medical/behavioural therapy.
Dr Gian Franco Adami and his team recently conducted a study to evaluate the long-term anti-diabetic effects of BPD in overweight or class 1 obese T2DM patients and reported results at 10 years after BPD performed in severely non-obese T2DM patients.
For their study, the researchers included 30 T2DM patients with BMI<35 and investigated them at one, five and ten years after BPD. They further compared the results with those of 30 T2DM patients followed for ten years on pharmacological and/or behavioural conventional therapy. They assessed the anthropometric, biochemical, and clinical records for complications.
Key findings of the study:
- Upon analysis, the researchers found a marked reduction in the mean levels of fasting blood glucose (FBG) and serum glycated hemoglobin (HbA1C) at 1 year after BPD.
- They noted that the values remained slightly above the diabetic range throughout the entire follow-up.
- They observed T2DM remission in about 50% of the cases at 5 and 10 years after the operation.
- However, they noted that 16 patients (53%) developed severe BPD-related complications and ten patients had a surgical revision of the operation.
- They also reported death in the BPD group, one patient for malignant lymphoma and two patients after surgical revision.
- Among the control group, they observed no changes in the diabetic status with FBG and HbA1C mean values higher than those recorded in the BPD patients at any follow-up time.
- They also noted that all T2DM subjects of the control group were alive at the end of the 10-year follow-up.
The authors concluded, "Despite satisfactory long-term metabolic outcomes, these data indicate that BPD should be used with caution as a metabolic procedure in the treatment of T2DM in overweight or class 1 obese patients."
For further information:
DOI: https://doi.org/10.1007/s11695-021-05870-4.
