Skip to main content

Advertisement

SpringerLink
Log in

Metabolic Surgery: Roux-en-Y Gastric Bypass and Variables Associated with Diabetes Remission in Patients with BMI <35

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Metabolic results of bariatric surgery have determined an expansion of its traditional indications, being increasingly performed in non-severely obese patients, especially in type 2 diabetes mellitus (T2DM). Our aim is to determine the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) in T2DM remission in patients with body mass index (BMI) below 35 kg/m2 and the variables associated with T2DM remission after surgery. Retrospective analysis of diabetic patients with BMI <35 kg/m2 who underwent LRYGB in our center between 2002 and 2010 was done. We analyzed patient’s demographics, comorbidities, BMI, excess weight loss percentage (EWLp), complications, and metabolic results at 3 years. Univariate and multivariate analyses were performed to determine variables associated with T2DM remission. One hundred patients were included. Sixty patients (60 %) were women; median age was 48 years old (interquartile range (IQR) 42–54), and median preoperative BMI was 32.7 kg/m2 (IQR 31.6–34.1). Median preoperative duration of T2DM was 4 years (IQR 2–7), with 49, 30, 2, and 18 % on treatment with one, two, and three hypoglycemic agents and insulin, respectively. Ninety-four percent achieved 36-month follow-up, and at this time, median EWLp was 93 % (IQR 67–121). A total of 53.2, 9.6, 25.5, and 11.7 % achieved a T2DM complete remission, partial remission, improvement, and no improvement, respectively. T2DM remission only was associated with non-insulin use in multivariate analysis, with an OR = 15.1 (2.8–81.2) and p = 0.002. LRYGB is a reliable and effective treatment in diabetic patients with a BMI <35 kg/m2 at 3 years. T2DM remission’s best results are observed in non-insulin diabetic patients.

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
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4–14.

    Article  CAS  PubMed  Google Scholar 

  2. Nguyen NT, Nguyen XM, Lane J, et al. Relationship between obesity and diabetes in a US adult population: findings from the National Health and Nutrition Examination Survey, 1999–2006. Obes Surg. 2011;21(3):351–5.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Brethauer SA, Aminian A, Romero-Talamás H, et al. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg. 2013;258(4):628–36.

    PubMed  Google Scholar 

  5. Alexandrides TK, 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. 2007;17(2):176–84.

    Article  PubMed  Google Scholar 

  6. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.

    Article  CAS  PubMed  Google Scholar 

  7. Carlsson LM, Peltonen M, Ahlin S, et al. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med. 2012;367(8):695–704.

    Article  CAS  PubMed  Google Scholar 

  8. Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Lecube A, Burguera B, Rubio MA. Breaking therapeutic inertia: should metabolic surgery be considered one more option for the treatment of type 2 diabetes mellitus? Endocrinol Nutr. 2012;59(5):281–3.

    Article  PubMed  Google Scholar 

  10. Kasama K, Mui W, Lee WJ, et al. IFSO-APC consensus statements 2011. Obes Surg. 2012;22(5):677–84.

    Article  PubMed  Google Scholar 

  11. Dixon JB, Zimmet P, Alberti KG, et al. Bariatric surgery: an IDF statement for obese type 2 diabetes. Diabet Med. 2011;28(6):628–42.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. American Diabetes Association. Standards of medical care in diabetes—2012. Diabetes Care. 2012;35 Suppl 1:S11–63.

    Google Scholar 

  13. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology. 2012;142(7):1592–609.

    Article  PubMed  Google Scholar 

  14. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.

    Article  PubMed  Google Scholar 

  15. Cohen R, Pinheiro JS, Correa JL, et al. Laparoscopic Roux-en-Y gastric bypass for BMI <35 kg/m(2): a tailored approach. Surg Obes Relat Dis. 2006;2(3):401–4.

    Article  PubMed  Google Scholar 

  16. Lee WJ, Chong K, Chen CY, et al. Diabetes remission and insulin secretion after gastric bypass in patients with body mass index <35 kg/m2. Obes Surg. 2011;21(7):889–95.

    Article  PubMed  Google Scholar 

  17. Lee WJ, Wang W, Lee YC, et al. Effect of laparoscopic mini-gastric bypass for type 2 diabetes mellitus: comparison of BMI >35 and <35 kg/m2. J Gastrointest Surg. 2008;12(5):945–52.

    Article  PubMed  Google Scholar 

  18. Huang CK, Shabbir A, Lo CH, et al. Laparoscopic Roux-en-Y gastric bypass for the treatment of type II diabetes mellitus in Chinese patients with body mass index of 25–35. Obes Surg. 2011;21(9):1344–9.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Navarrete Aulestia S, Leyba J, Navarrete LLS, et al. Roux-en-Y gastric bypass for treatment of patients with DM type 2 and BMI of 30 to 35 Kg/m2. Nutr Hosp. 2012;27(4):1160–5.

    CAS  PubMed  Google Scholar 

  20. Liang Z, Wu Q, Chen B, et al. Effect of laparoscopic Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus with hypertension: a randomized controlled trial. Diabetes Res Clin Pract. 2013;101(1):50–6.

    Article  Google Scholar 

  21. Lee WJ, Chong K, Ser KH, et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg. 2011;146(2):143–8.

    Article  PubMed  Google Scholar 

  22. Cohen RV, Pinheiro JC, Schiavon CA, et al. Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes Care. 2012;35(7):1420–8.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Lakdawala M, Shaikh S, Bandukwala S, et al. Roux-en-Y gastric bypass stands the test of time: 5-year results in low body mass index (30–35 kg/m(2)) Indian patients with type 2 diabetes mellitus. Surg Obes Relat Dis. 2013;9(3):370–8.

    Article  PubMed  Google Scholar 

  24. Rossi M, Serpa Neto A, Rossi FM, et al. Percentage of excess BMI lost correlates better with improvement of metabolic syndrome after Roux-en-Y gastric bypass in morbidly obese subjects: anthropometric indexes and gastric bypass. Surg Obes Relat Dis. 2009;5(1):11–8.

    Article  PubMed  Google Scholar 

  25. Chikunguwo SM, Wolfe LG, Dodson P, et al. Analysis of factors associated with durable remission of diabetes after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010;6(3):254–9.

    Article  PubMed  Google Scholar 

  26. Hall TC, Pellen MG, Sedman PC, et al. Preoperative factors predicting remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass surgery for obesity. Obes Surg. 2010;20(9):1245–50.

    Article  PubMed  Google Scholar 

  27. Kadera BE, Lum K, Grant J, et al. Remission of type 2 diabetes after Roux-en-Y gastric bypass is associated with greater weight loss. Surg Obes Relat Dis. 2009;5(3):305–9.

    Article  PubMed  Google Scholar 

  28. Blackstone R, Bunt JC, Cortes MC, et al. Type 2 diabetes after gastric bypass: remission in five models using HbA1c, fasting blood glucose, and medication status. Surg Obes Relat Dis. 2012;8(5):548–55.

    Article  PubMed  Google Scholar 

  29. Dixon JB, Chuang LM, Chong K, et al. Predicting the glycemic response to gastric bypass surgery in patients with type 2 diabetes. Diabetes Care. 2013;36(1):20–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Via MA, Mechanick JI. The role of bariatric surgery in the treatment if type 2 diabetes: current evidence an clinical guidelines. Curr Atheroscler Rep. 2013;15(11):366.

    Article  PubMed  Google Scholar 

  31. Shimizu H, Timratana P, Schauer PR, et al. Review of metabolic surgery for type 2 diabetes in patients with a BMI <35 kg/m2. J Obes. 2012;2012:147256.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Ramos-Levi A, Sanchez-Pernaute A, Matia P, et al. Diagnosis of diabetes remission after bariatic surgery may be jeopardized by remission criteria and previous hypoglycemic treatment. Obes Surg. 2013;23(10):1520–6.

    Article  PubMed  Google Scholar 

  33. Boza C, Munoz R, Salinas J, et al. Safety and efficacy of Roux-en-Y gastric bypass to treat type 2 diabetes mellitus in non-severely obese patients. Obes Surg. 2011;21(9):1330–6.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by the Chilean grant FONDECYT REG 1120877.

Conflict of Interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, Región Metropolitana, Santiago, Chile

    Camilo Boza, David A. Daroch, Felipe I. León, José P. Salinas, Diego A. Barros, Ricardo A. Funke & Fernando J. Crovari

  2. Department of Nutrition and Diabetes, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile

    Patricio Valderas

Authors
  1. Camilo Boza
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patricio Valderas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David A. Daroch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Felipe I. León
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. José P. Salinas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Diego A. Barros
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ricardo A. Funke
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fernando J. Crovari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Camilo Boza.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Boza, C., Valderas, P., Daroch, D.A. et al. Metabolic Surgery: Roux-en-Y Gastric Bypass and Variables Associated with Diabetes Remission in Patients with BMI <35. OBES SURG 24, 1391–1397 (2014). https://doi.org/10.1007/s11695-014-1218-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-014-1218-x

Keywords

Search

Navigation