Single-anastomosis duodenal-ileal bypass with sleeve gastrectomy for diabetes: predictors of remission and metabolic outcomes in a multicenter study

Jack W Sample ¹, Daniel Cottam ², Romulo Lind ³

⁰Department of Surgery, Mayo Clinic, Rochester, Minnesota.

Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery +

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April 30, 2025

View abstract on PubMed

Summary

Single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) effectively treats obesity and type 2 diabetes, achieving significant weight loss and remission. Higher BMI and insulin use predict poorer remission outcomes.

Area Of Science

Metabolic and Bariatric Surgery
Endocrinology
Obesity Medicine

Background

The single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) integrates restrictive sleeve gastrectomy (SG) with the hypoabsorptive benefits of gastric bypass.
SADI-S has shown promising results in terms of weight loss and surgical feasibility.

Purpose Of The Study

To assess the efficacy of SADI-S in managing obesity and type 2 diabetes mellitus.
To identify predictors of type 2 diabetes remission following SADI-S.

Main Methods

A multicenter retrospective review of 419 adult patients with obesity and type 2 diabetes who underwent SADI-S between 2013 and 2023.
Type 2 diabetes remission defined as HbA1C <6.5% without antidiabetic medication.
Analysis of demographic, bariatric, and metabolic parameters.

Main Results

Mean BMI was 47.1 kg/m², with a mean total weight loss of 31.9% over a 2.0-year follow-up.
A 60.1% type 2 diabetes remission rate was observed.
Preoperative insulin use and higher BMI negatively predicted remission; greater weight loss positively correlated with remission.

Conclusions

SADI-S is a durable and effective metabolic and bariatric surgery for individuals with obesity and type 2 diabetes.
Predictors for successful type 2 diabetes remission include lower preoperative BMI and absence of insulin use.

Keywords:

Diabetes Metabolic and bariatric surgery Obesity Remission SADI-S