Ten-year Remission Rates in Insulin-treated Type 2 Diabetes Following Biliopancreatic Diversion with Duodenal Switch

Abstract Objective The aim of this study was to assess long-term glycemic outcomes in insulin-treated patients with type 2 diabetes (T2D) following biliopancreatic diversion with duodenal switch (BPD-DS) and identify predictors of sustained diabetes remission or relapse. Background BDP-DS confers the highest rate of T2D remission compared to other bariatric procedures. Previous studies suggest that type of anti-diabetic therapy used prior to surgery and duration of disease influence post-surgical glycemic outcomes. Short-term, progressive improvement in insulin sensitivity and beta-cell function following metabolic surgery in patients with non-insulin treated T2D has been demonstrated. Whether patients with more advanced disease can achieve sustained remission remains unclear. Methods Data from 141 patients with insulin-treated T2D who underwent BPD-DS between 1994 and 2006 with 10 years of follow up data was collected from a prospective electronic database. Results Follow-up was available in 132 patients (91%). At ten years following metabolic surgery, 90 patients (68.1%) had a complete remission of diabetes, 3 (2.3%) had a partial remission, 21 (15.9%) had an improvement and 3 (2.3%) were unchanged in their diabetes status. Fourteen patients died during the 10-year follow-up period. Relapse after an initial period of remission occurred in 15 (11.4%) patients. Insulin discontinuation was achieved in 97%. Duration of diabetes was an independent predictor of non-remission at 10 years. Conclusions The BPD-DS maintains remission at 10 years post-operatively in patients with more advanced diabetes. Long-term benefits of the BPD-DS on weight loss and glycemic control should be considered when offering metabolic surgery to patients with insulin-treated T2D.