Ileal Interposition with Sleeve Gastrectomy for Control of Type 2 Diabetes

Background: Bariatric surgery offers the best solution in management of obesity and related metabolic ailments, paving the way for a concept termed metabolic surgery. We report the results of a novel surgical procedure on glycemic control and metabolic syndrome in poorly controlled type 2 diabetes. Methods: Ten patients (four men, six women) underwent laparoscopic surgical procedure of sleeve gastrectomy and ileal interposition. All patients had diabetes for more than 3 years with poor control despite use of oral hypoglycemic agents (OHAs) and/or insulin. The primary outcome was remission of diabetes (hemoglobin A1c <7% without OHAs/insulin), and secondary outcomes were change in OHA requirement, components of metabolic syndrome, insulin resistance, and microalbuminuria. Results: We report the preliminary postoperative follow-up data of 9.1 +/- 5.3 months (range, 2-16 months). Participants had a mean age of 48.2 +/- 9 years (range, 34-62 years), duration of diabetes of 11 +/- 5.7 years (range, 4-25 years), and preoperative body mass index of 33.8 +/- 6.5 kg/m(2). Seven patients had diabetes remission, and the remaining three showed significantly decreased OHA requirement. All participants had weight loss ranging between 15% and 30% and had remission of hypertension. Microalbuminuria (96.8 +/- 19.1 vs. 46.7 +/- 10.1mg/L, P = 0.03568) and insulin resistance as assessed by homeostasis assessment model of insulin resistance (5.2 +/- 2.1 vs. 1.8 +/- 0.9, P = 0.0005) decreased significantly after surgery. Conclusions: Our preliminary observations demonstrated the feasibility, safety, and efficacy of this novel surgical procedure in type 2 diabetes. Further long-term data from more patients are necessary to confirm these findings.