Skip to main content

Advertisement

SpringerLink
Log in

Refractory and new-onset diabetes more than 5 years after gastric bypass for morbid obesity

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Few studies about long-term glucose homeostasis in bariatric patients are available. In a prospective protocol that included retrospective information, outcome of patients with both impaired and normal fasting blood glucose (FBG) was monitored to assess frequencies and correlates.

Methods

Patients submitted to Roux-en-Y gastric bypass were classified as group I, elevated FBG, and group II, normal controls. Those in group I with improvement in FBG were defined as responsive and the others as refractory. Group II participants progressing to new-onset diabetes (NOD) or prediabetes represented NOD cases; the remaining were listed as stable controls. FBG was the main endpoint, but HbA1c results were considered, along with diet composition and general biochemical profile.

Results

Among 97 selected patients, 51 belonged to group I (52.4 ± 10.5 years, 29.6 % males, initial body mass index (BMI) 58.4 ± 13.4, current BMI 35.1 ± 8.4 kg/m2) and 46 to group II (48.2 ± 10.5 years, 19.6 % males, initial BMI 55.5 ± 8.8, current BMI 33.9 ± 6.9 kg/m2). Follow-up was 7–9 years, and 31.4 % (16/51) of group I were classified as refractory, whereas 15.2 % (7/46) of the controls converted to NOD. Multivariate analysis pointed out higher current BMI, older age, consumption of antidiabetic drugs, and male gender as features of refractory cases, whereas NOD participants were not significantly different from non-progressing controls.

Conclusions

This is the first investigation, to the best of our knowledge, to underscore the correlates of refractory and NOD within the bariatric context. Further studies are recommended as such information could be valuable for patient selection, prognostic scoring, and outcome monitoring.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I (2009) Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 122:248–256

    Article  PubMed  Google Scholar 

  2. Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, Dahlgren S, Larsson B, Narbro K, Sjostrom CD, Sullivan M, Wedel H (2004) Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 351:2683–2693

    Article  PubMed  Google Scholar 

  3. DiGiorgi M, Rosen DJ, Choi JJ, Milone L, Schrope B, Olivero-Rivera L, Restuccia N, Yuen S, Fisk M, Inabnet WB, Bessler M (2010) Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up. Surg Obes Relat Dis 6:249–253

    Article  PubMed  Google Scholar 

  4. Gunther K, Vollmuth J, Weissbach R, Hohenberger W, Husemann B, Horbach T (2006) Weight reduction after an early version of the open gastric bypass for morbid obesity: results after 23 years. Obes Surg 16:288–296

    Article  PubMed  Google Scholar 

  5. Pories WJ, Swanson MS, MacDonald KG, Long SB, Morris PG, Brown BM, Barakat HA, de Ramon RA, Israel G, Dolezal JM (1995) Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 222:339–350

    Article  PubMed  CAS  Google Scholar 

  6. Long SD, O’Brien K, MacDonald KG Jr, Leggett-Frazier N, Swanson MS, Pories WJ, Caro JF (1994) Weight loss in severely obese subjects prevents the progression of impaired glucose tolerance to type II diabetes. A longitudinal interventional study. Diabetes Care 17:372–375

    Article  PubMed  CAS  Google Scholar 

  7. Al Harakeh AB, Burkhamer KJ, Kallies KJ, Mathiason MA, Kothari SN (2010) Natural history and metabolic consequences of morbid obesity for patients denied coverage for bariatric surgery. Surg Obes Relat Dis 6:591–596

    Article  PubMed  Google Scholar 

  8. American Diabetes Association (2010) Diagnosis and classification of diabetes mellitus. Diabetes Care 34(Suppl 1):S62–S69

    Article  Google Scholar 

  9. Ishida RK, Faintuch J, Kuga R, Ribeiro AS, Sakai P, Barbeiro HV, Barbeiro DF, Soriano FG, Cecconello I (2007) Microbial flora of the stomach after gastric bypass for morbid obesity. Obes Surg 17:752–758

    Article  PubMed  Google Scholar 

  10. MacDonald KG Jr, Long SD, Swanson MS, Brown BM, Morris P, Dohm GL, Pories WJ (1997) The gastric bypass operation reduces the progression and mortality of non-insulin-dependent diabetes mellitus. J Gastrointest Surg 1:213–220

    Article  PubMed  Google Scholar 

  11. Sugerman HJ, Wolfe LG, Sica DA, Clore JN (2003) Diabetes and hypertension in severe obesity and effects of gastric bypass induced weight loss. Ann Surg 237:751–756

    PubMed  Google Scholar 

  12. Higa K, Ho T, Tercero F, Yunus T, Boone KB (2010) Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis 16:1151–1152

    Google Scholar 

  13. Gracia-Solanas JA, Elia M, Aguilella V, Ramirez JM, Martínez J, Bielsa MA, Martínez M (2011) Metabolic syndrome after bariatric surgery. Results depending on the technique performed. Obes Surg 21:179–185

    Article  PubMed  Google Scholar 

  14. Petrie JR, Pearson ER, Sutherland C (2011) Implications of genome wide association studies for the understanding of type 2 diabetes pathophysiology. Bioche Pharmacol 81:471–477

    Article  CAS  Google Scholar 

  15. Rubino F, Gagner M (2002) Potential of surgery for curing type 2 diabetes mellitus. Ann Surg 236:554–559

    Article  PubMed  Google Scholar 

  16. Hussain A, Mahmood H, El-Hasani S (2009) Can Roux-en-Y gastric bypass provide a lifelong solution for diabetes mellitus? Can J Surg 52:E269–E275

    PubMed  Google Scholar 

  17. Morais AA, Faintuch J, Leal AA, Noe JA, Bertollo DM, Morais RC, Cabrini D (2011) Inflammation and biochemical features of bariatric candidates: does gender matter? Obes Surg 21:71–77

    Article  PubMed  Google Scholar 

  18. Dias MCG, Ribeiro AG, Scabim VM, Faintuch J, Zilberstein B, Gama-Rodrigues JJ (2006) Dietary intake of female bariatric patients after anti-obesity gastroplasty. Clinics (Sao Paulo) 61:93–98

    Article  Google Scholar 

  19. Papakonstantinou E, Triantafillidou D, Panagiotakos DB, Koutsovasilis A, Saliaris M, Manolis A, Melidonis A, Zampelas A (2010) A high-protein low-fat diet is more effective in improving blood pressure and triglycerides in calorie-restricted obese individuals with newly diagnosed type 2 diabetes. Eur J Clin Nutr 64:595–602

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The support of CNPq Research Grant 300392/2008-7 and CAPES Postgraduate Scholarships (CMY and SYH) is appreciated.

Disclosures

C. M. Yamaguchi, J. Faintuch, S. Y. Hayashi, J. J. Faintuch, and I. Cecconello have no conflict of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Hospital das Clinicas, ICHC 9th Floor, Rm 9077, Sao Paulo, 05403, Brazil

    Camila M. Yamaguchi, Joel Faintuch, Silvia Y. Hayashi, Jacob J. Faintuch & Ivan Cecconello

Authors
  1. Camila M. Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joel Faintuch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Silvia Y. Hayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jacob J. Faintuch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ivan Cecconello
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joel Faintuch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yamaguchi, C.M., Faintuch, J., Hayashi, S.Y. et al. Refractory and new-onset diabetes more than 5 years after gastric bypass for morbid obesity. Surg Endosc 26, 2843–2847 (2012). https://doi.org/10.1007/s00464-012-2256-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-012-2256-x

Keywords

Search

Navigation