Role of surgical method in the treatment of type 2 diabetes mellitus associated with obesity

Aim. To improve treatment of type 2 diabetes mellitus associated with obesity by analyzing the results of surgical treatment during a 24 months follow-up. Material and Methods. The study included 75 patients with type 2 diabetes and obesity. In the study, 32 patients of patients underwent biliopancreatic diversion with duodenal switch; sleeve gastrectomy was performed in 33 patients, and Roux-n-Y gastric bypass - in 10 patients. Mean age of the patients was 47.6±8.9 years - from 29 to 67 years (33 for men and 42 for women). Mean body weight before the procedure was 149.1±30.5 kg (from 87 to 236 kg), the average of excess body weight - 90,1±24,9 kg (51 to 147 kg). The average body mass index before intervention was 50.4±9.5 kg/m2 (from 30.1 to 75.4 kg/m2). The criteria of the American Diabetic Association (1998) were used to diagnose type 2 diabetes. The criteria recommended by Brethauer were used to evaluate the results of surgical treatment of type 2 diabetes mellitus and obesity. Results and Discussion. Combined oral hypoglycaemic therapy was given in 45 (60%) patients; insulin therapy in combination with oral hypoglycaemic drugs - in 11 (14.7%) patients. On admission, in 26 (34.7%) patients 2 type of diabetes mellitus was compensated; 9 (12%) patients had sub-compensation of diabetes; and 40 (53.3%) patients had decompensation. Biliopancreatic diversion with duodenal switch was performed in 32 patients - 18 women and 14 men. Mean body mass index was 53.6±8.3 kg/m2 (40.5 to 75.4 kg/m2). All patients were treated with open access. Sleeve gastrectomy was done in 33 patients - 19 women and 14 men. The average body mass index was 48.2±9.8 kg/m2 (from 30 to 73.9 kg/m2). All procedures were done laparoscopically. Roux-n-Y gastric bypass was performed in 10 patients - 5 women and 5 men. In 6 patients, laparoscopic access was used, and in 4 - open access was performed. In 2 years, 68 (90.7%) of the patients who remained in the study were asked for a follow-up visit. According to the laboratory tests, 22 (73,3%) patients after sleeve gastrectomy has complete stable remission. In the group of patients with biliopancreatic diversion, complete stable remission of type 2 diabetes was achieved in 27 (93.1%) patients, and in the gastric bypass group - in 7 (77,8%) patients. No clinically and laboratory significant hypoglycemia was diagnosed. The indicated results of surgical treatment were associated with a decrease in the level of insulin resistance markers (HOMA-I