Characteristics of carbohydrate metabolism in the surgical treatment of morbid obesity and type 2 diabetes mellitus using various modifications of biliopancreatic diversion with duodenal switch

Abstract

BACKGROUND: Biliopancreatic diversion (BPD), and its modifications, is the most effective surgical bariatric treatment of morbid obesity and associated metabolic disturbances. However, at present comparative studies of the dynamics of carbohydrate metabolism after various modifications of the BPD are lacking.AIM: comparative assessment for the effectiveness of biliopancreatic diversion with duodenal switch (BPD-DS) in the HessMarceau and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) modifications for correcting carbohydrate metabolism disorders and achieving remission of Diabetes mellitus type 2 (DM2) within a period of up to five years after both operations.MATERIALS AND METHODS: within the framework of a prospective study, 200 patients with morbid obesity were operated on using the BPD-DS (group 1, n = 100) and SADI (group 2, n = 100) methods, the dynamics of clinical and laboratory parameters was analyzed in groups depending on the presence, or absence, of DM2, with an emphasis on the analysis of indicators of carbohydrate metabolism. DM2 was diagnosed in 35 (35.0%) patients in group 1 (BPD - DS) and 45 (45.0%) in group 2 (SADI). All patients underwent a standard set of clinical, laboratory and instrumental examination methods before, immediately after and at 3, 6, 9, 12, 18, 24, 36, 48 and 60 months after the operation.RESULTS: 5 years after the operation, complete remission of DM2 was achieved in 38 (84.4%) and 32 (91.4%) patients from the SADI and BPD-DS groups, respectively, and 7 (15.6%) and 3 (8.6 %) of patients achieved partial remission. The level of C-peptide, which also decreased after both modifications of BPS, was higher in patients after BPS in the SADI modification, both in patients with DM2 36 months (p<0.05), and in patients without DM2 at 3, 12 and 24 months after surgery (p<0.05).CONCLUSION: The frequency of achieving stable remission of DM2 is comparable in both groups. The carbohydrate profile of patients after SADI is characterized by higher levels of glucose and C-peptide compared to BPD-DS at different periods of follow-up over five years.