Mesenteric Visceral Lipectomy Improves Glucose Tolerance in Patients With Type 2 Diabetes: 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 individuals with obesity and poorly controlled type 2 diabetes (T2D) (glycated hemoglobin [HbA1c] = 8.9% ± 0.2%; fasting plasma glucose [FPG] = 211 ± 12 mg/dL). Results At month 6, both HbA1c and FPG significantly declined to 7.7% (P = .01) and 140 mg/dL (P < .01). At month 12, both the FPG (172 mg/dL, P = .02) and HbA1c (8.1%, P = .10) tended to increase. Time in range (continuous glucose monitoring) increased from 22% to 74% (month 6, P < .001) and 50% (month 12, P < .05). Suppression of endogenous (hepatic) glucose production increased from 29% to 45% (P < .05) and to 43% (P < .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 < .05) at month 12. Hepatic fat content (hydrogen-1 magnetic resonance spectroscopy) decreased significantly (23.9 ± 3.7 to 19.1 ± 3.4%, P < .005) at month 12. Insulin secretion and disposition index during oral glucose tolerance testing increased more than 2-fold at month 6 (both P < .05), and these improvements persisted at 12 months. Conclusion Mesenteric visceral lipectomy (MVL) shows potential as a novel, minimally invasive approach to improve glycemic control in patients with suboptimally controlled T2D, but further controlled studies are needed to confirm these findings and better understand the potential benefits of MVL.