Surendra Ugale, MD. Kirloskar Hospital & Asian Bariatrics
Introduction: Diabetic nephropathy is the leading cause of chronic kidney disease, and associated with increased cardiovascular mortality. 30-40% of diabetics develop nephropathy. The aim of this study was to evaluate the regression of nephropathy in poorly controlled type-2 diabetics (T2DM), by laparoscopic ileal interposition with BMI-adjusted sleeve gastrectomy (IISG), through better glycemic control, even in non-obese patients.
Methods: This was a retrospective, 2-center study in 60 patients. 51 were men and 21 women. Mean age was 50.7 years (22–70). Mean BMI was 33.8 kg/m2 (23.5-51). Insulin therapy was been used by 41 % of the patients. Mean duration of T2DM was 11.5 years (3-32). Mean HbA1c was 9.2 % (6.1—15.8). Microalbuminuria (30-299µg/min) was diagnosed in 47 % of the patients and macroalbuminuria (>300 µg/min) in 53 %. The mean clearance of creatinine was 62.2 mL/min (33-128). 48 % of the patients had creatinine clearance ≤60 mL/min. Arterial hypertension present in 66%.
Results: Mean post-operative follow-up was 14 months (8–60). Mean postoperative BMI was 25.2 kg/m2(19.8 – 34.5). Mean HbA1c was 6.9 % (5.2—9.6). Overall, 52.4 % of the patients achieved remission of T2DM. Microalbuminuria was normalized in 89%. Macro-albuminuria persisted in 8.6 % . The mean clearance of creatinine was 98mL/min (48 – 120). Arterial hypertension was controlled in 90% of the patients
Conclusion: Laparoscopic IISG seems to be a promising procedure to control diabetic nephropathy, possibly through remission of micro-albuminuria and T2DM.