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

BACKGROUND

The single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) combines the restrictive aspects of a sleeve gastrectomy (SG) with the hypoabsorptive advantages of a gastric bypass. SADI-S has demonstrated excellent weight loss outcomes and technical feasibility.

OBJECTIVES

To evaluate the benefits of SADI-S in patients with obesity and type 2 diabetes mellitus.

SETTING

Academic and private practice hospitals, United States.

METHODS

Following the institutional review board (IRB) approval, a multicenter retrospective review was conducted to evaluate adult patients with obesity and type 2 diabetes who underwent SADI-S between January 1, 2013, and April 1, 2023. Type 2 diabetes remission was defined as a hemoglobin A1C (HbA1C) value of <6.5% in the absence of any antidiabetic medication use. Patient demographics and bariatric and metabolic-related parameters were collected.

RESULTS

A total of 419 consecutive patients were identified with a median age of 50.0 years (interquartile range [IQR] 17) and a mean body mass index (BMI) of 47.1 ± 8.9 kg/m. The mean percentage of total weight loss (%TWL) was 31.9% with a type 2 diabetes remission rate of 60.1% and a mean follow-up period of 2.0 years. Two hundred twenty-six patients were included in the final analysis. Preoperative insulin use and higher BMI were negative predictors of type 2 diabetes remission, whereas greater %TWL was associated with a higher likelihood of type 2 diabetes remission at the last follow-up. On average, patients maintained reduced HbA1C values.

CONCLUSIONS

SADI-S is an effective and durable metabolic and bariatric surgery (MBS) for patients with obesity and type 2 diabetes. Patients with higher preoperative BMI and insulin use are less likely to experience type 2 diabetes remission after surgery.