Cargando…
Effects of Bilio-Pancreatic Diversion on Diabetic Complications: A 10-year follow-up
OBJECTIVE: The surgical option could represent a valid alternative to medical therapy in some diabetic patients. However, no data are available on long-term effects of metabolic surgery on diabetic complications. We aimed to determine whether patients with newly diagnosed type 2 diabetes who underwe...
Autores principales: | , , , , , , , , , , |
---|---|
Formato: | Texto |
Lenguaje: | English |
Publicado: |
American Diabetes Association
2011
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041181/ https://www.ncbi.nlm.nih.gov/pubmed/21282343 http://dx.doi.org/10.2337/dc10-1761 |
_version_ | 1782198411970215936 |
---|---|
author | Iaconelli, Amerigo Panunzi, Simona De Gaetano, Andrea Manco, Melania Guidone, Caterina Leccesi, Laura Gniuli, Donatella Nanni, Giuseppe Castagneto, Marco Ghirlanda, Giovanni Mingrone, Geltrude |
author_facet | Iaconelli, Amerigo Panunzi, Simona De Gaetano, Andrea Manco, Melania Guidone, Caterina Leccesi, Laura Gniuli, Donatella Nanni, Giuseppe Castagneto, Marco Ghirlanda, Giovanni Mingrone, Geltrude |
author_sort | Iaconelli, Amerigo |
collection | PubMed |
description | OBJECTIVE: The surgical option could represent a valid alternative to medical therapy in some diabetic patients. However, no data are available on long-term effects of metabolic surgery on diabetic complications. We aimed to determine whether patients with newly diagnosed type 2 diabetes who underwent bilio-pancreatic diversion (BPD) had less micro- and macrovascular complications than those who received conventional therapy. RESEARCH DESIGN AND METHODS: This was an unblinded, case-controlled trial with 10-years’ follow-up, conducted from July 1998 through October 2009 at the Day Hospital of Metabolic Diseases, Catholic University, Rome, Italy. A consecutive sample of 110 obese patients (BMI >35 kg/m(2)) with newly diagnosed type 2 diabetes was enrolled. The study was completed by 50 subjects. The main outcome measure was long-term effects (10 years) of BPD versus those associated with conventional therapy on microvascular outcome, micro- and macroalbuminuria, and glomerular filtration rate (GFR). Secondary measures included macrovascular outcomes, type 2 diabetes remission, glycated hemoglobin, and hyperlipidemia. RESULTS: Ten-year GFR variation was −45.7 ± 18.8% in the medical arm and 13.6 ± 24.5% in the surgical arm (P < 0.001). Ten-year hypercreatininemia prevalence was 39.3% in control subjects and 9% in BPD subjects (P = 0.001). After 10 years, all BPD subjects recovered from microalbuminuria, whereas microalbuminuria appeared or progressed to macroalbuminuria in control subjects. Three myocardial infarctions, determined by electrocardiogram, and one stroke occurred in control subjects. After the 10-year follow-up, coronary heart disease (CHD) probability was 0.22 ± 0.10 and 0.05 ± 0.04 in the medical and surgical groups, respectively (P < 0.001). Remission from type 2 diabetes was observed in all patients within 1 year of surgery. Surgical and medical subjects had lost 34.60 ± 10.25 and 0.38 ± 6.10% of initial weight at the 10-year follow-up (P < 0.001). CONCLUSIONS: Renal and cardiovascular complications were dramatically reduced in the surgical arm, indicating long-term benefits of BPD on diabetic complications, at least in the case of morbid obesity with decompensated type 2 diabetes. |
format | Text |
id | pubmed-3041181 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | American Diabetes Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-30411812012-03-01 Effects of Bilio-Pancreatic Diversion on Diabetic Complications: A 10-year follow-up Iaconelli, Amerigo Panunzi, Simona De Gaetano, Andrea Manco, Melania Guidone, Caterina Leccesi, Laura Gniuli, Donatella Nanni, Giuseppe Castagneto, Marco Ghirlanda, Giovanni Mingrone, Geltrude Diabetes Care Original Research OBJECTIVE: The surgical option could represent a valid alternative to medical therapy in some diabetic patients. However, no data are available on long-term effects of metabolic surgery on diabetic complications. We aimed to determine whether patients with newly diagnosed type 2 diabetes who underwent bilio-pancreatic diversion (BPD) had less micro- and macrovascular complications than those who received conventional therapy. RESEARCH DESIGN AND METHODS: This was an unblinded, case-controlled trial with 10-years’ follow-up, conducted from July 1998 through October 2009 at the Day Hospital of Metabolic Diseases, Catholic University, Rome, Italy. A consecutive sample of 110 obese patients (BMI >35 kg/m(2)) with newly diagnosed type 2 diabetes was enrolled. The study was completed by 50 subjects. The main outcome measure was long-term effects (10 years) of BPD versus those associated with conventional therapy on microvascular outcome, micro- and macroalbuminuria, and glomerular filtration rate (GFR). Secondary measures included macrovascular outcomes, type 2 diabetes remission, glycated hemoglobin, and hyperlipidemia. RESULTS: Ten-year GFR variation was −45.7 ± 18.8% in the medical arm and 13.6 ± 24.5% in the surgical arm (P < 0.001). Ten-year hypercreatininemia prevalence was 39.3% in control subjects and 9% in BPD subjects (P = 0.001). After 10 years, all BPD subjects recovered from microalbuminuria, whereas microalbuminuria appeared or progressed to macroalbuminuria in control subjects. Three myocardial infarctions, determined by electrocardiogram, and one stroke occurred in control subjects. After the 10-year follow-up, coronary heart disease (CHD) probability was 0.22 ± 0.10 and 0.05 ± 0.04 in the medical and surgical groups, respectively (P < 0.001). Remission from type 2 diabetes was observed in all patients within 1 year of surgery. Surgical and medical subjects had lost 34.60 ± 10.25 and 0.38 ± 6.10% of initial weight at the 10-year follow-up (P < 0.001). CONCLUSIONS: Renal and cardiovascular complications were dramatically reduced in the surgical arm, indicating long-term benefits of BPD on diabetic complications, at least in the case of morbid obesity with decompensated type 2 diabetes. American Diabetes Association 2011-03 2011-02-17 /pmc/articles/PMC3041181/ /pubmed/21282343 http://dx.doi.org/10.2337/dc10-1761 Text en © 2011 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details. |
spellingShingle | Original Research Iaconelli, Amerigo Panunzi, Simona De Gaetano, Andrea Manco, Melania Guidone, Caterina Leccesi, Laura Gniuli, Donatella Nanni, Giuseppe Castagneto, Marco Ghirlanda, Giovanni Mingrone, Geltrude Effects of Bilio-Pancreatic Diversion on Diabetic Complications: A 10-year follow-up |
title | Effects of Bilio-Pancreatic Diversion on Diabetic Complications: A 10-year follow-up |
title_full | Effects of Bilio-Pancreatic Diversion on Diabetic Complications: A 10-year follow-up |
title_fullStr | Effects of Bilio-Pancreatic Diversion on Diabetic Complications: A 10-year follow-up |
title_full_unstemmed | Effects of Bilio-Pancreatic Diversion on Diabetic Complications: A 10-year follow-up |
title_short | Effects of Bilio-Pancreatic Diversion on Diabetic Complications: A 10-year follow-up |
title_sort | effects of bilio-pancreatic diversion on diabetic complications: a 10-year follow-up |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041181/ https://www.ncbi.nlm.nih.gov/pubmed/21282343 http://dx.doi.org/10.2337/dc10-1761 |
work_keys_str_mv | AT iaconelliamerigo effectsofbiliopancreaticdiversionondiabeticcomplicationsa10yearfollowup AT panunzisimona effectsofbiliopancreaticdiversionondiabeticcomplicationsa10yearfollowup AT degaetanoandrea effectsofbiliopancreaticdiversionondiabeticcomplicationsa10yearfollowup AT mancomelania effectsofbiliopancreaticdiversionondiabeticcomplicationsa10yearfollowup AT guidonecaterina effectsofbiliopancreaticdiversionondiabeticcomplicationsa10yearfollowup AT leccesilaura effectsofbiliopancreaticdiversionondiabeticcomplicationsa10yearfollowup AT gniulidonatella effectsofbiliopancreaticdiversionondiabeticcomplicationsa10yearfollowup AT nannigiuseppe effectsofbiliopancreaticdiversionondiabeticcomplicationsa10yearfollowup AT castagnetomarco effectsofbiliopancreaticdiversionondiabeticcomplicationsa10yearfollowup AT ghirlandagiovanni effectsofbiliopancreaticdiversionondiabeticcomplicationsa10yearfollowup AT mingronegeltrude effectsofbiliopancreaticdiversionondiabeticcomplicationsa10yearfollowup |