Biliopancreatic Diversion Versus Gastric Bypass in the Surgical Treatment of Type 2 Diabetes Mellitus in Patients with Body Mass Index Below 35

Abstract
Background: Type 2 Diabetes Mellitus (T2DM) is an important health problem worldwide with about 23% of patients with morbid obesity have type 2 DM. Bariatric surgery originally developed solely as a weight-reduction therapy, but has been found to improve T2DM and to reduce rates of chronic vascular disease and death. The International Diabetes Federation have recommended consideration of bariatric surgery for control of T2DM.
Methods: A total number of 45 patients were randomized into two groups, the first group with 26 patients (n=26) were submitted for Biliopancreatic Diversion (BPD) and the second group with 19 patients (n=19) were planned for Roux-en-Y Gastric Bypass (RYGBP). The main objective was to compare the efficacy of bariatric surgery in inducing clinical remission of T2DM mellitus in patients with body mass index less than 35 in both groups.
Results: The operations were performed laparoscopically in all patients. There were no conversions, operative compli-cations or mortality. Data were collected during a two-year follow-up period and were analyzed at the following periods; pre-operatively and post-operatively at 1 months, 4 months, at 8 months, at 1 year and 2 years. The analyzed parameters included the levels of BMI, FBG, HbA1c, Triglycerides and cholesterol. There were no statistical significant difference between the two groups regarding the BMI, mean glucose levels, and HbA1c levels. However the levels of triglycerides were higher in the BPD group, while the levels of cholesterol were higher in the RYGBP group during most of the follow-up periods.
Regarding the diabetes outcome, there was significant reduction of patients who showed diabetes remission at one year and those who remains remittent at 2 year, while the number of patients who showed diabetes failure tripled at 2 years follow-up.
Conclusions: Although, BPD is known to have a better effect on type 2 DM in the higher BMI group. There was no difference regarding glycemic control between BPD and RYGBP. And both operations failed to maintain glycemic control at long term follow-up periods.