Mesenteric Visceral Lipectomy (MVL) Improves Glucose Tolerance in Type 2 Diabetes Patients: A Pilot Study

Abstract

Context: Increased mesenteric visceral fat is associated with the metabolic syndrome, insulin resistance, and type 2 diabetes.

Methods: Using Targeted Cell Separation and Extraction Technology (TC-SET), we examined the effect of removal of intra-abdominal fat, specifically small bowel mesenteric fat, on glycemic control and insulin sensitivity in 7 obese, poorly controlled type 2 diabetic individuals (HbA1c = 8.9±0.2%; FPG = 211±12 mg/dl).

Results: At month 6, both HbA1c and FPG significantly declined to 7.7% (p=0.01) and 140 mg/dl (p<0.01). At month 12, both the FPG (172 mg/dl, P=0.02) and HbA1c (8.1%, P=0.10) tended to increase. Time-in-range (CGM) increased from 22% to 74% (month 6, p<0.001) and 50% (month 12, p<0.05). Suppression of endogenous (hepatic) glucose production increased from 29% to 45% (p<0.05) and to 43% (p<0.01) at months 6 and 12, respectively; whole body (muscle) insulin-mediated glucose disposal did not change significantly at months 6 and 12. Body weight (106.8 to 103.3 kg) and percent body fat (33.3 to 31.6%) both decreased slightly (p<0.05) at month 12. Hepatic fat content (1H-MRS) decreased significantly (23.9±3.7 to 19.1±3.4%, P<0.005) at month 12. Insulin secretion and disposition index during OGTT increased more than 2-fold at month 6 (both p<0.05), and these improvements persisted at 12 months.

Conclusion: Mesenteric visceral lipectomy shows potential as a novel, minimally invasive approach to improve glycemic control in suboptimally controlled type 2 diabetes patients, but further controlled studies are needed to confirm these findings and better understand the potential benefits of MVL.

Keywords: Mesenteric visceral lipectomy; endogenous glucose production; glycemic control; insulin secretion; insulin sensitivity; intra-abdominal fat; targeted cell separation and extraction technology; type 2 diabetes.