Effect of the duodeno jejunal bypass liner in insulin resistance and cardiovascular risk in obese patients with type 2 diabetes

OBJETIVO: Avaliar a eficácia do dispositivo endoscópico temporário de exclusão duodeno jejunal (DEED) na redução da resistência à insulina e do risco cardiovascular em pacientes obesos mórbidos portadores de diabetes tipo 2 (DMT2), utilizando a relação Triglicerídeos/colesterol HDL (TG/HDL), porcentagem de perda de peso e controle glicêmico. MÉTODO: Neste estudo foram incluídos 54 pacientes implantados com o DEED e acompanhados por um período de 6 meses. Todos apresentavam uma relação TG/HDL com valor acima de 3,5, sugerindo uma maior resistência insulínica e um perfil lipídico compatível com um maior risco cardiovascular. O valor da relação inicial foi comparado com o valor obtido após 6 meses do implante do dispositivo, com o objetivo de avaliar se houve redução desse valor, indicando melhora na resistência insulínica e redução do risco cardiovascular. Também foi avaliada a melhora dos níveis de hemoglobina glicada (HbA1c) e a perda de peso obtida com o uso do dispositivo. Estes dois últimos achados foram correlacionados com a redução da relação TG/HDL para avaliar a presença de dependência entre os fatores. RESULTADOS: Todos os pacientes implantados com o DEED apresentaram redução significativa dos níveis de HbA1c, sendo que a maior parte dos pacientes (70,3%) obtiveram o controle do diabetes, com níveis abaixo de 7% ao final do estudo. Todos os pacientes também apresentaram redução do peso, com perda média de 12,6% do peso absoluto inicial. Foi observada redução da relação TG/HDL de 5,75 para 4,36 ao final do estudo (p 0,0001), com 42,6% dos pacientes apresentando relação final abaixo de 3,5. A melhora da relação TG/HDL apresentou uma importante associação com uma perda de peso maior que 10% do peso inicial. CONCLUSÃO: O DEED mantido por um período de 6 meses é eficaz na obtenção do controle do diabetes tipo 2, perda de peso e redução da relação TG/HDL em pacientes obesos mórbidos portadores de diabetes mellitus tipo 2. Porém, a melhora da relação TG/HDL está fortemente associada à perda de mais de 10% do peso inicialOBJECTIVE: To evaluate the efficacy of the duodeno jejunal bypass liner (DJBL) in reducing insulin resistance and cardiovascular risk in morbidly obese patients with type 2 diabetes (T2DM). For this purpose we used the Triglycerides / HDL cholesterol ratio (TG / HDL), percentage of weight loss and glycemic control. METHODS: This study included 54 patients implanted with the DJBL and followed for a period of 6 months. All had a TG / HDL ratio equal or above 3.5, suggesting greater insulin resistance and lipid profile consistent with increased cardiovascular risk. The initial value of the ratio was compared with the value obtained 6 months after the device implantation, in order to assess whether this value decreased, indicating an improvement in insulin resistance and reduction in the cardiovascular risk. We also evaluated the improvement in glycated hemoglobin (HbA1c) and weight loss achieved with the device, and its relationship with the reduction of TG/HDL ratio. RESULTS: All patients implanted with the DJBL showed significant reduction in HbA1c levels. Most patients (70.3%) achieved diabetes control, with HbA1c levels below 7% by the end of the study. All patients also had a statistically significant weight reduction, with an average loss of 12.6% of initial weight. We observed an important improvement in insulin resistance and metabolic syndrome, with a significant reduction of the TG/HDL ratio from 5.75 to 4.36 (p = 0.0001) and 42.6% of the patients presenting a TG/HDL ratio lower than 3.5 at the end of the study. The improvement of the TG / HDL ratio presented a significant association with weight loss greater than 10% of initial weight. CONCLUSION: The DJBL maintained for a period of 6 months is effective in obtaining control of type 2 diabetes, weight loss and reduction in the TG / HDL ratio in morbidly obese patients with diabetes mellitus type 2. However, the improvement of the TG / HDL ratio is strongly associated with loss of more than 10% of the initial weigh

Improvement of Insulin Resistance and Reduction of Cardiovascular Risk Among Obese Patients with Type 2 Diabetes with the Duodenojejunal Bypass Liner

This study aims to evaluate the effectiveness of the duodenojejunal bypass liner (DJBL) in the improvement of insulin resistance and reduction of cardiovascular risk among morbidly obese patients with type 2 diabetes mellitus, using the triglyceride/high-density lipoprotein (HDL) cholesterol ratio, percentage of weight loss, and glycemic control. We used the TG/HDL ratio with a cutoff value of 3.5 to identify patients with insulin resistance. The value of the initial ratio was compared with the ratio obtained 6 months after implantation to evaluate whether an improvement in insulin resistance occurred. We also evaluated the improvement of glycated hemoglobin levels and the weight loss resulted from the use of the device and correlated that with the improvement of the TG/HDL ratio. All patients implanted with the device presented a statistically significant reduction of the HbA1c levels, with most patients (70.3%) obtaining diabetes control with HbA1c levels lower than 7% at the end of the study. All patients also presented a significant weight reduction, with an average loss of 12.6% of their initial weight. We observed an important improvement in insulin resistance and metabolic syndrome, with a significant reduction of the TG/HDL ratio from 5.75 to 4.36 (p < 0.001) and 42.6% of the patients presenting a TG/HDL ratio lower than 3.5 at the end of the study. The DJBL, when used for a period of 6 months, is effective in the control of diabetes, weight loss, improvement of insulin resistance, and decrease of cardiovascular risk among morbidly obese patients with type 2 diabetes mellitus