Effects of Biliopanceratic Diversion on Type 2 Diabetes in Patients With BMI 25 to 35

Abstract

BPD improves or resolves diabetes in BMI 25 to 35 without causing excessive weight loss, its action being on insulin sensitivity and beta-cell function. The strikingly different response between morbidly obese and low BMI patients might depend on different beta-cell defect. ClinicalTrials.gov Identifier: NCT00996294.

Bariatric Surgery: The Indications in Metabolic Disease

“…BPD has been tested with success in improving glucose homeostasis in those with a BMI <35 kg/m 2 [33]. In this study, half of the participants had a BMI <30 kg/m 2 and all had T2DM (with a mean duration of 11 years) and suboptimal glycemic control [with a mean HbA1c of >9% (75 mmol/mol)].…”

“…In this study, half of the participants had a BMI <30 kg/m 2 and all had T2DM (with a mean duration of 11 years) and suboptimal glycemic control [with a mean HbA1c of >9% (75 mmol/mol)]. Over a 1-year follow-up period, over 80% of this cohort (n = 30) achieved glycemic targets with a HbA1c of <7% (53 mmol/mol) off glycemic pharmacotherapy [33]. The mean BMI stabilized to 25 kg/m 2 and there was no excessive weight loss [33].…”

“…Over a 1-year follow-up period, over 80% of this cohort (n = 30) achieved glycemic targets with a HbA1c of <7% (53 mmol/mol) off glycemic pharmacotherapy [33]. The mean BMI stabilized to 25 kg/m 2 and there was no excessive weight loss [33]. …”

“…Thus, even if they reduce their body weight, the relative benefit obtained may be less than patients with a higher BMI who lose the same percentage of weight [33]. However, the less obese population may still obtain an advantage by deferring the onset of diabetic complications [33].…”

BPD and BPD-DS Concerns and Results

“…More than 90% of type 2 diabetic patients are not morbidly obese, being in the BMI range 25 to 35. Recently, with the aim to investigate if the BPD effect is maintained in the above BMI range, we submitted to BPD 30 T2DM patients belonging to that range, with the obvious rationale that, if the action of BPD is specific, and thus independent of weight loss, it should be maintained also in the patients who, being only mildly obese or simply overweight, lose little or no weight after operation (Scopinaro et al, 2011). The reason why BPD does not entail risk of excessive or undue weight loss is that there is a maximum energy absorption capacity after the operation, which corresponds to a weight of stabilization of about 85 kg for men and 70 kg for women (Scopinaro et al, 2000).…”