Duodenal-jejunal bypass for the treatment of type 2 diabetes in patients with body mass index of 22-34 kg/m2: a report of 2 cases.

Type 2 diabetes mellitus (T2DM) is a worldwide epidemic, with an estimated 333 million individuals expected to be affected by 2025 [1]. T2DM is the most serious co-morbidity of obesity. It can be prevented and/or cured by bariatric surgery in severely obese patients [2– 4]. The clinical resolution of diabetes, usually defined as independence of all antidiabetic medications, has been reported to occur in 47–70% of patients after restrictive procedures, 80 –98% after Roux-en-Y gastric bypass (RYGB), and 92–100% after biliopancreatic diversion (BPD) [5]. The dramatic improvement in glycemic control after RYGB and BPD typically occurs too fast to be accounted for by weight loss alone, as reviewed by Rubino and Gagner in 2002 [6], suggesting that these 2 operations may have a direct impact on glucose homeostasis. Both RYGB and BPD bypass the duodenum and proximal jejunum. In 2004, Rubino and Marescaux [7] demonstrated that duodenal-jejunal bypass (DJB), an operation that simply excludes the duodenum and proximal jejunum without restriction of the gastric volume, achieved glycemic control in nonobese rats with T2DM, in the absence of weight loss or decreased caloric intake. These findings suggest that DJB might be beneficial in patients with T2DM. Consistent with this possibility are clinical observations showing that BPD can normalize plasma insulin and blood glucose levels in