Shedding more than weight: Metabolic and bariatric surgery and the journey to insulin independence in insulin-treated type 2 diabetes.

Autor:	Abi Mosleh K; Division of Metabolic and Abdominal Wall Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, United States., Ghusn W; Department of Internal Medicine, Boston University Medical Center, Boston, MA, United States., Salameh Y; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States., Jawhar N; Division of Metabolic and Abdominal Wall Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, United States., Hage K; Division of Metabolic and Abdominal Wall Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, United States., Mundi MS; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, United States., Abu Dayyeh BK; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States., Ghanem OM; Division of Metabolic and Abdominal Wall Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, United States. Electronic address: Ghanem.omar@mayo.edu.
Jazyk:	angličtina
Zdroj:	Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2024 Oct; Vol. 28 (10), pp. 1613-1621. Date of Electronic Publication: 2024 Jul 31.
DOI:	10.1016/j.gassur.2024.07.018
Abstrakt:	Background: Type 2 diabetes (T2D) imposes a significant health burden, necessitating lifelong pharmacological interventions, with insulin being one of the cornerstone therapies. However, these regimens are associated with health risks and psychological stressors. This study aimed to examine the rates of insulin-treated T2D remission and cessation or reduction in the dosage of insulin therapy after metabolic and bariatric surgery (MBS). Methods: This was a retrospective analysis of patients with a preoperative diagnosis of insulin-treated T2D who underwent primary laparoscopic sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or biliopancreatic diversion with duodenal switch (BPD/DS) with a minimum of 3 and up to 5 years of follow-up. The average daily dose for each type of insulin, measured in units, was calculated at annual intervals. Results: Among 287 patients included, 201 (70%) underwent RYGB, 66 (23%) underwent SG, and 20 (7%) underwent BPD/DS. The average follow-up period was 4.6 ± 0.7 years. At 5 years follow-up, the mean total weight loss was the highest in the BPD/DS subgroup at 37.5% ± 11.6%. Insulin usage decreased significantly from complete dependency at baseline to 36.2% just 1 year postoperatively, and the use of noninsulin antidiabetic drugs decreased from 79.4% initially to 26.1%. These results were sustained throughout the study period. The subgroup analysis indicated that, 5 years after surgery, T2D remission was the highest after BPD/DS (73.7%) compared with RYGB (43.2%) and SG (23.3%) (P < .001). Conclusion: MBS is a transformative approach for achieving significant remission in insulin-treated T2D and reducing insulin requirements. Our findings reinforce the efficacy of these surgical interventions, particularly highlighting the promising potential of procedures that bypass the proximal small intestine, such as BPD/DS and RYGB. Competing Interests: Declaration of Competing Interest B.K.A. has received consulting fees from Endogenex, endo-TAGSS, Metamodix, and BFKW; consulting fee and grant/research support from USGI, Cairn Diagnostics, Aspire Bariatrics, and Boston Scientific; speaker honorarium from Olympus Corp and Johnson & Johnson; speaker honorarium and grant/research support from Medtronic and EndoGastric Solutions; and research support/grant from Apollo Endosurgery Inc and Spatz Medical. O.M.G. is a consultant for Olympus Corporation, Regeneron Pharmaceuticals, and Medtronic. The other authors (K.A., W.G., Y.S., N.J., K.H., and M.S.M.) declare no competing interests. These disclosures have no effect on the results of this study. (Copyright © 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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