Remission of Type 2 Diabetes Mellitus by Ileal Interposition with Sleeve gastrectomy

Background: Laparoscopic leal inter Position(II) with sleeve gastrectomy (SG) is an upcoming procedure that helps to improve metabolic profile and leads to weight reduction without causing significant malabsorption, paving the way for usage of the term “metabolic surgery.”
Objectives: To determine the impact of this novel procedure on glycemic control and the accompanying metabolic abnormalities of type 2 diabetes mellitus (T2DM).
Patients and Methods: The II and SG procedures were performed in 38 patients (M:F = 24:14). Despite their usage of optimum dosage of oral hypoglycemic agents (OHAs) and/or insulin, all patients exhibited poorly controlled T2DM (mean glycosylated hemoglobin [HbA1C]: 9.57 ± 2 %). The primary outcome was a remission of diabetes (HbA1C < 6.5% without OHA/insulin). Secondary outcomes included a reduced need for antidiabetic agents and a reduction in symptoms of metabolic syndrome.
Results: The mean follow up time was 11.3 ± 9 months (range: 3–32 months). Participants were 47.5 ± 8.8 years of age (range: 29–64 years), had diabetes 
for a mean duration of 9.7 ± 8.8 years (range: 1–32 years), and had a mean preoperative body mass index (BMI) of 32.05 ± 7.5 kg/m2. Thirty patients (79%) exhibited hypertension, 19 (50%) had dyslipidemia, and 19 (50%) harbored significant microalbuminuria. Postoperatively, glycemic parameters (fasting and post lunch blood sugars, and HbA1C) improved for all patients (P < 0.05) at all intervals. Eighteen patients (47%) experienced a remission in diabetes and the remaining patients received a significantly lower OHA dosage. All patients demonstrated 15–30% weight loss (P < 0.05). Twenty-seven patients (90%) experienced a remission in hypertension. At 2 years, the mean reduction in HbA1C (36%) was greater than the reduction in BMI (20%). A declining trend in postoperative levels of lipids and microalbuminuria became evident, although the reduction was significant for microalbuminuria only.
Conclusions: The laparoscopic II with SG procedure appears promising for gaining control of T2DM and associated morbidities. To substantiate our preliminary findings, additional long-term data that involves a larger number of patients is necessary.