Patients in this group will undergo bariatric surgery. There are two parts to this procedure. One is the restrictive type of weight loss surgery, which reduces the stomach size. The other type prevents the body from absorbing fats and sugar properly, as the small intestine will be attached to the small stomach, bypassing most of the stomach and upper part of the small intestine. This surgery will be performed using a minimally invasive technique known as laparoscopic keyhole surgery.

Patients in this group will be subjected to strict adherence to diet, optimisation of diabetic medications and close monitoring of blood glucose and HbA1c.

Diabetes Mellitus, Type 2

Overweight

Patients will undergo bariatric surgery. A clear liquid high protein diet will be started in the first two postoperative days. If no complications were detected by physical examination, patients will be stimulated to walk and will be dismissed from the hospital on postoperative day 3. Patients will be subjected to a strict adherence to diet and close monitoring of their blood glucose and HbA1c levels during the study period. Standard follow-up includes a visit to the outpatient clinic at 1, 2, 3, 4 weeks after surgery, then 3, 6, 9, 12, 18, 24 months and after that, a life-long annual visit. Glycaemic control at home will be maintained as in the preoperative period and patients will need to inform the results of their blood glucose levels to the doctor during each follow-up visits.

SADJB-SG group

Patients will be subjected to strict adherence to their diet, optimisation of their diabetic medications and close monitoring of their blood glucose and HbA1c levels at 0, 6, 12, 24 months. The endocrinologist will be monitoring the patients in this group. Detailed individualized lifestyle and dietary counseling will be given by a dietitian emphasizing on nutrition knowledge, the timing of meal with medication, portion control, and increasing daily physical activity level.

IMT group

Hospital Serdang

Hospital Kuala Lumpur

A Diabetes Improvement in Medical Therapy Versus SADJB Study

Single Anastomosis Duodeno Jejunal Bypass With Sleeve Gastrectomy (SADJB-SG) Versus Intensive Medical Therapy (IMT) in the Treatment of Type 2 Diabetes Mellitus Among Asian Patients With BMI 23.5 - 30 kg/m2: A Clinical Trial

The HbA1c level is measured in percentage

Fasting blood glucose level is measured in mmol/l

BMI is calculated as weight (kg)/height (m^2)

Fasting blood samples will be taken early in the morning. In the study, serum concentrations of the following lipids will be measured using automated clinical chemistry analyzer: triglycerides, total cholesterol, HDL, LDL. LDL-Subfractionation will be done using Quantrimetrix Lipoprint system. The measurements will be performed before the planned intervention and then at intervals of 6, 12 and 24 months. The results will be presented in respective units (mmol/L).

In the study, serum concentrations of the following analytes will be measured on an automated clinical chemistry analyzer: total protein (g/L), albumin (g/L), bilirubin (umol/L), alkaline phosphatase (U/L), alanine transaminase (U/L), aspartate aminotransferase (U/L), gamma-glutamyl transferase (U/L). ELISA Technique will be used to analyze the following parameters in serum: leptin (pg/mL), adiponectin, FGF19 (pg/mL), and TNF-alpha (pg/mL). The measurements will be performed before the planned intervention and then at intervals of 6, 12 and 24 months.

In the study, serum incretins GLP-1 (pmol/L) and GIP (pmol/L) will be analyzed using ELISA technique. The measurements will be performed before the planned intervention and then at intervals of 6, 12 and 24 months.

The genotypic and allelic frequencies of genetic polymorphisms of GCG, GLP1R, DPP4, GIP, GIPR, PCSK1 gene are analyzed by PCR method. The significant association (p<0.05) of genetic polymorphisms between the subjects is considered as the genetic risk factors/genetic marker for the development of T2DM.

Dr. Tikfu Gee

Senior lecturer/ consultant

Universiti Putra Malaysia

The study will involve two groups with equal allocation of patients in the intensive medical therapy (IMT) group and Single Anastomosis Duodeno Jejunal Bypass with Sleeve Gastrectomy (SADJB-SG) group with stratification by use of insulin at screening. All patients who agree to participate in this study will be assigned to one of the treatment groups by the doctor without randomization.

Non-alcoholic Fatty Liver Disease

Rifaximin: 1100mg/day, 550 mg tablets 1 × 2 before meals

gamma glutamyl transferase/nekroos

A Diabetes Improvement in Medical Therapy Versus SADJB Study

Rifaximin Modify the Pathogenesis of Non-Alcoholic Fatty Liver Disease (NAFLD)

Evaluation of DHA for the Treatment of PSC

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