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Resolution of Diabetes Mellitus and Metabolic Syndrome following Roux-en-Y Gastric Bypass and a Variant of Biliopancreatic Diversion in Patients with Morbid Obesity

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Background

Obesity is associated with increased prevalence of type 2 diabetes mellitus (DM2) and metabolic syndrome and increased morbidity and mortality. Bariatric surgery results in significant and long-term weight loss. Two of the most effective and popular bariatric procedures are Roux-en-Y gastric bypass (RYGBP) and biliopancreatic diversion (BPD). The objective of this study was to investigate the effects of RYGBP and BPD-RYGBP, a variant of BPD with a lower rate of metabolic deficiencies than BPD, on DM2 and the major components of metabolic syndrome in patients with morbid obesity and DM2.

Methods

The prospective database of our unit, from June 1994 until May 2006, was analyzed and 137 patients with DM2 were found. 26 underwent RYGBP (BMI 46.1±2.9 kg/m2) and 111 BPD-RYGBP (BMI 59.7±10.6 kg/m2). 7 of the patients were on insulin (4.90%) and 37 on oral hypoglycemic agents (25.87%). Pre- and postoperative medications, and clinical and biochemical parameters were considered in the analysis. The mean follow-up was 26.39±21.17 months.

Results

Excess weight loss was ∼70% after either procedure. DM2 resolved in 89% and 99% of the cases following RYGBP and BPD-RYGBP, respectively. 2 years after BPD-RYGBP all the patients had blood glucose <110 mg/dl, 95% had normal cholesterol, 92% normal triglycerides and 82% normal blood pressure. The respective values following RYGBP were 66%, 33%, 78% and 44%. Uric acid decreased significantly only after BPD-RYGBP. Liver enzymes improved in both groups.

Conclusions

RYGBP and BPD-RYGBP are safe and lead to normalization of blood glucose, lipids, uric acid, liver enzymes and arterial pressure in the majority of patients, although this variant of BPD was more effective than RYGBP.We suggest that further studies should also investigate its usefulness in patients with milder degrees of obesity, DM2 and metabolic syndrome.

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Author information

Authors and Affiliations

  1. Associate Professor of Internal Medicine – Endocrinology, Head of Endocrine Division, Department of Internal Medicine, School of Medicine, University of Patras, Patras, Greece

    Theodore K. Alexandrides

  2. Lecturer of Surgery, Nutrition Support and Morbid Obesity Unit, Department of Surgery, School of Medicine, University of Patras, Patras, Greece

    George Skroubis

  3. Professor and Chairman of Surgery, Nutrition Support and Morbid Obesity Unit, Department of Surgery, School of Medicine, University of Patras, Patras, Greece

    Fotis Kalfarentzos MD, FACS

  4. Professor and Chairman, Department of Surgery, School of Medicine, University of Patras, Platia Voriou Ipirou 5, 264 41, Patras, Greece

    Fotis Kalfarentzos MD, FACS

Authors
  1. Theodore K. Alexandrides
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  2. George Skroubis
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  3. Fotis Kalfarentzos MD, FACS
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Correspondence to Fotis Kalfarentzos MD, FACS.

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Alexandrides, T.K., Skroubis, G. & Kalfarentzos, F. Resolution of Diabetes Mellitus and Metabolic Syndrome following Roux-en-Y Gastric Bypass and a Variant of Biliopancreatic Diversion in Patients with Morbid Obesity. OBES SURG 17, 176–184 (2007). https://doi.org/10.1007/s11695-007-9044-z

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  • DOI: https://doi.org/10.1007/s11695-007-9044-z

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