Long-term control of type 2 diabetes mellitus and the other major components of the metabolic syndrome after biliopancreatic diversion in patients with BMI <35 kg/m2

Background: Bariatric operations are the most powerful means of curing type 2 diabetes mellitus (T2D) and the other major components of the metabolic syndrome. Despite the very frequent occurrence of metabolic disturbances in patients with BMI from 30 to 35, there is a general reluctance to operate on these patients, as their disease is considered less severe. Methods: 7 T2D obese patients with mean BMI <35 underwent BPD between 1976 and 1996 at the Azienda Ospedaliera Universitaria San Martino of Genoa, Italy. Mean age was 49 years, mean body weight 91 kg, and mean waist circumference 115 (M) and 98 (F) cm. The mean follow-up was 13 (10-18) years. All 7 patients had abnormally high values of serum triglyceride, serum cholesterol, and arterial pressure. Results: In all patients, serum glucose was normalized at 1, 2, and 3 years. In 5 patients, a slight increase of serum glucose above 125 mg/dl was observed at or around 5 years, the values being maintained at all subsequent times, with no one value higher than 160 mg ever being recorded. The other 2 patients showed full resolution of diabetes at all follow-up times. Both serum cholesterol and triglyceride values fell to normal 1 year after BPD, and remained within the normal range in all 7 patients during the entire follow-up observation. Arterial pressure normalized in 6 cases and was improved in I case. No patient had excessive weight loss at any postoperative time. Conclusions: T2D patients with BMI <35 have very severe metabolic disturbances. Surgical therapy for these patients is warranted, and it should be performed as soon as possible, before the rapid evolution of the pattern leads them to a point where even the most effective metabolic surgery operation could be insufficient to yield complete and permanent control of their diabetes.