IMMUNOLOGICAL EVALUATION OF PATIENTS WITH TYPE 2 DIABETES MELLITUS SUBMITTED TO METABOLIC SURGERY

Background :

Immunological and inflammatory mechanisms play a key role in the development andprogression of type 2 diabetes mellitus.

Aim :

To raise the hypothesis that alterations in immunological parameters occur afterduodenojejunal bypass surgery combined with ileal interposition withoutgastrectomy, and influences the insulin metabolism of betacells.

Methods :

Seventeen patients with type 2 diabetes mellitus under clinical management weresubmitted to surgery and blood samples were collected before and six months aftersurgery for evaluation of the serum profile of proinflammatory (IFN-γ, TNF-α,IL-17A) and anti-inflammatory cytokines (IL-4, IL-10). In addition, anthropometricmeasures, glucose levels and insulin use were evaluated in each patient.

Results :

No changes in the expression pattern of proinflammatory cytokines were observedbefore and after surgery. In contrast, there was a significant decrease in IL-10expression, which coincided with a reduction in the daily insulin dose, glycemicindex, and BMI of the patients. Early presentation of food to the ileum may haveinduced the production of incretins such as GLP-1 and PYY which, together withglycemic control, contributed to weight loss, diabetes remission and theconsequent good surgical prognosis of these patients. In addition, the control ofmetabolic syndrome was responsible for the reduction of IL-10 expression in thesepatients.

Conclusion :

These findings suggest the presence of low-grade inflammation in these patientsduring the postoperative period, certainly as a result of adequate glycemiccontrol and absence of obesity, contributing to a good outcome of surgery.