http://www.diabeteshealth.com/read/2009/06/09/6228/duodenal- switch-surgery-better-against-type-2-diabetes-than-gastric-b ypass/

Duodenal Switch Surgery Better Against Type 2 Diabetes Than Gastric Bypass

Jun 10, 2009

Over the years, gastric bypass surgery has proven an effective means of controlling-and even reversing-type 2 diabetes in
"super-obese" patients (those with a body mass index of 50 or above; usually more than 200 pounds above ideal body weight).

But now University of Chicago researchers have concluded that another type of surgery, called a duodenal switch, is even more effective at controlling such obesity-related conditions as diabetes, high cholesterol, and high blood pressure.

In gastric bypass surgery, surgeons create a small pouch that is separated from the rest of the stomach. Food bypasses the stomach, instead going through the pouch. The smaller size and capacity of the pouch lessens appetite and reduces the amount of food that the body can digest at any one time.

In contrast, duodenal switch surgery modifies the stomach itself, reshaping it into a long, narrow tube. At the same time, the small intestine is changed to reduce the amount of calories it can absorb.

Following either surgery, many obese patients are able to cease taking the medications used to treat their conditions. After tracking the results of the two types of surgery on 350 super-obese patients, however, the researchers noted that the duodenal switch had decisively better postoperative outcomes than the gastric bypass.

• One hundred percent of duodenal switch patients completely stopped taking their diabetes medications, versus 60 percent of gastric bypass patients.
• Sixty-eight percent of duodenal switch patients completely stopped taking their hypertension medications, versus 38.6 percent of gastric bypass patient
• Seventy-two percent of duodenal switch patients completely stopped taking their medications for high cholesterol, versus 26 percent of gastric bypass patients

However, one area in which the gastric bypass outperformed the duodenal switch was in the resolution of acid reflux disease. Almost 77 percent of gastric bypass patients enjoyed a cessation of the disease, versus 48.5 percent of patients undergoing duodenal switch.

One drawback to the duodenal switch is potential vitamin deficiencies or even malnutrition brought on by the modification of the small intestine's ability to absorb nutrients. Because obese people often already have pre-operative nutritional deficiencies, the University of Chicago researchers say that duodenal switch patients may routinely require vitamin supplementation. 

Results of the study were presented recently at Digestive Disease Week® 2009 in Chicago.

Damn it Diana, you know I have DS envy! 

Same here, Cindy.

This old girl sure misses her NSAIDS and Advil. My poor knees and hips wish I would have known more about the different surgeries prior to taking the RNY plunge.

That's my story and I am sticking to it!

 I may not be a DSer, but I still adore you

I was prediabetic before surgery,  which I was unaware of until the pre-op labs done the morning of surgery. By the time I left the hospital (2 days post DS) it was gone. I have had perfect blood sugar since. This surgery has been a lifesaver to me as I have a strong family history of diabetes and was headed down that road myself.
  I wish they did the "switch part" to cure diabetes like they do in Europe, it would help so many of my family members struggling with this disease.

Hopefully more published things like this and more insurance companies will come around.
I wish like everything my insurance would have covered a DS.

Pre-ops: even if your insurance says they don't cover the DS, that it is "experimental" or "not medically necessary" for you, you can fight it.  Many of us DSers had to fight for the surgery of our choice, and I believe most of those who do, win.  If your insurance covers RNY, you are likely to be able to force them to accept the DS.  More than half of the states and the Federal government use CHDR/Maximus for external medical reviews, and their reviewers are VERY pro-DS.

It just sucks that several insurers refuse to change their policies, even though their DS denials get overturned regularly.  "CoughKaisercough."

X-post from reply on California forum:
I'd like to know more information than this excerpt provides ... such as:

1. How many of the 350 people were DS patients? How many were RNYers?
2. The percentages are one thing... but how many of the 350 in the study suffered from diabetes before surgery? and of that number, how many were DS and how many were RNY. It's easier to make 100% of 20 people than it is to make 100% of 100 people. It is unclear whether or not the 350 people all suffered from all three diseases (hypertension, high cholesterol, and diabetes) And if all of them didn't have all three diseases, the numbers for those who did suffer from each disease are not mentioned.
3. At what point did they test to see if the patients were or were not diabetic? A week after surgery?  a month?  a year? longer?

I could assume the patients studied were about equal in DSers and RNYers, and that the time they tested for diabetes was as far out as possible, but I wouldn't know from the article, and it's not good to assume. For a thorough review of a study those things are necessary. Methods is a huuuge part of believability, and this article only gives the bare minimum statistics aimed to prove its point. Not saying it's wrong, but from what it tells me I certainly don't know its right.

Remember 27.9% of statistics are made up on the spot!

I do not have the full text for the study mentioned here.  However, I do have the full text of a Meta-analysis by Buchwald that demonstrated that the DS is better for the resolution of diabetes and also shows better weight loss results.  " Weight loss and diabetes resolution were greatest for patients undergoing biliopancreatic diversion/duodenal switch, followed by gastric bypass, and least for banding procedures."

I would be happy to send that study to you if you will PM me with your email address.

Red