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Surgical cure for type 2 diabetes by foregut or hindgut operations: a myth or reality? A systematic review

Yan Mei Goh1, Zaher Toumi2, Ravindra S Date3,4

  • 1Department of Upper Gastrointestinal Surgery, Lancashire Teaching Hospital NHS Foundation Trust, Chorley, PR7 1PP, UK.

Surgical Endoscopy
|May 20, 2016
PubMed
Abstract

Insights

Foregut and hindgut procedures for type 2 diabetes mellitus (T2DM) show variable remission rates. However, their outcomes are not superior to sleeve gastrectomy alone, questioning their clinical utility.

Area of Science:

  • Metabolic surgery
  • Gastroenterology
  • Endocrinology

Background:

  • Bariatric surgery effectively induces type 2 diabetes mellitus (T2DM) remission.
  • Foregut and hindgut hypotheses suggest T2DM remission mechanisms independent of weight loss.
  • Investigational procedures based on these hypotheses aim to treat T2DM in non-obese and obese patients.

Purpose of the Study:

  • To review human procedures utilizing foregut and hindgut hypotheses for T2DM treatment.
  • To assess the outcomes of these novel T2DM treatment strategies.

Main Methods:

  • Systematic review of studies on investigational procedures for T2DM in humans.
  • Identification of procedures based on foregut and hindgut hypotheses.
  • Assessment of reported remission rates and outcomes.

Main Results:

  • Twenty-four studies reported novel T2DM procedures; only ten used glycated hemoglobin A1c (HbA1c) for remission definition.
  • Reported remission rates varied: 20-40% for duodenal-jejunal bypass (DJB), 73-93% for DJB with sleeve gastrectomy (DJB-SG), 62.5-100% for DJB sleeve (DJBS), and 47-95.7% for ileal interposition with sleeve gastrectomy (II-SG).
  • Using a predetermined HbA1c level for remission definition yielded lower rates (27%, 63%, 0%, and 65% for DJB, DJB-SG, DJBS, and II-SG, respectively).

Conclusions:

  • Foregut and hindgut-based procedures did not demonstrate superior outcomes compared to sleeve gastrectomy alone.
  • The complexity of these combined procedures, with comparable outcomes to simpler operations, raises questions about their utility in T2DM management.
Keywords:
Foregut theoryHindgut theoryRemission ot type 2 diabetes

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