Abstract
Objectives
To evaluate the Roux-en-Y gastric bypass (GBP) procedure for patients suffering from type 2 diabetes mellitus (T2DM) with body mass index (BMI) <28 kg/m2.
Methods
Thirty-one patients suffering from T2DM were selected to undergo laparoscopic Roux-en-Y gastric bypass surgery and were enrolled at Beijing Shijitan Hospital between November 2012 and December 2014. The fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), C-peptide, fasting insulin (FINS) and glucagon-like peptide-1 (GLP-1) of all patients were measured before and at 1, 3, 6 months after surgery. The results were compared and analyzed.
Results
Thirty-one patients suffering from T2DM successfully underwent GBP surgery (a mean age of 46 years), 14 were male and 17 were female. Among them, 7 patients had hypertriglyceridemia (HTG). The patients were followed up for 6 months. No major complications were found. The average BMI was 26.5 ± 1.4 kg/m2 before surgery. The average levels of FPG, HbA1c, C-peptide, FINS of all patients were statistically decreased after surgery, respectively, compared to those before surgery (P < 0.05). However, the mean GLP-1 of all patients was statistically increased after surgery compared to that before surgery (P < 0.05). At 6 months after surgery, 22 patients (71 %) achieved complete remission of T2DM with HbA1c < 6.5 %, 7 patients (23 %) gained partial remission of T2DM with 6.5 % ≤ HbA1c < 7.0 % and 2 patients (6 %) experienced no remission of T2DM. The mean serum triglyceride of 31 patients was statistically decreased after surgery compared to that before surgery (P < 0.05).
Conclusions
This research shows that the GBP procedure is safe and effective for T2DM patients with BMI <28 kg/m2, and the condition of patients with HTG was greatly improved. However, further studies with larger samples and long-term follow-up are needed.
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References
Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, Shan Z, Liu J, Tian H, Ji Q, Zhu D, Ge J, Lin L, Chen L, Guo X, Zhao Z, Li Q, Zhou Z, Shan G, He J, China National Diabetes and Metabolic Disorders Study Group (2010) Prevalence of diabetes among men and women in China. N Engl J Med 362:1090–1101
IDF Diabetes Atlas Group (2015) Update of mortality attributable to diabetes for the IDF Diabetes Atlas: estimates for the year 2013. Diabetes Res Clin Pract 109:461–465
Douglas IJ, Bhaskaran K, Batterham RL, Smeeth L (2015) Bariatric surgery in the United Kingdom: a cohort study of weight loss and clinical outcomes in routine clinical care. PLoS Med 22(12):e1001925
Ribaric G, Buchwald JN, McGlennon TW (2014) Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg 24:437–455
Pappachan JM, Viswanath AK (2015) Metabolic surgery: a paradigm shift in type 2 diabetes management. World J Diabetes 6:990–998
Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH (2009) The incidence of comorbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 9:88
Demaria EJ, Winegar DA, Pate VW, Hutcher NE, Ponce J, Pories WJ (2010) Early postoperative outcomes of metabolic surgery to treat diabetes from sites participating in the ASMBS bariatric surgery center of excellence program as reported in the bariatric outcomes longitudinal diabetes. Ann Surg 252:559–567
Maiz C, Alvarado J, Quezada N, Salinas J, Funke R, Boza C (2015) Bariatric surgery in 1119 patients with preoperative body mass index <35 (kg/m(2)): results at 1 year. Surg Obes Relat Dis 11:1127–1132
Basevi V, Di Mario S, Morciano C, Nonino F, Magrini N (2011) Comment on: American diabetes association. Standards of medical care in diabetes—2011. Diabetes Care 34(Suppl. 1):S11–S61
Chinese Society for Metabolic & Bariatric Surgery (CSMBS) (2014) Surgery guideline for Chinese obesity and type 2 diabetes. Chin J Pract Surg 34:1005–1010
Pories WJ, Swanson MS, MacDonald KG, Long SB, Morris PG, Brown BM, Barakat HA, deRamon 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 222:339–352
Scopinaro N, Adami GF, Marinari GM, Gianetta E, Traverso E, Friedman D, Camerini G, Baschieri G, Simonelli A (1998) Biliopancreatic diversion. World J Surg 22:936–946
Omotosho P, Mor A, Shantavasinkul PC, Corsino L, Torquati A (2016) Gastric bypass significantly improves quality of life in morbidly obese patients with type 2 diabetes. Surg Endosc 30(7):2857–2864
Dicker D, Yahalom R, Comaneshter DS, Vinker S (2015) Long-term outcomes of three types of bariatric surgery on obesity and type 2 diabetes control and remission. Obes Surg (Epub ahead of print)
Lee WJ, Wang W, Lee YC, Huang MT, Ser KH, Chen JC (2008) Effects of laparoscopic mini-gastric bypass for type 2 diabetes mellitus: comparison of BMI >35 and <35 kg/m2. J Gastrointest Surg 12:945–952
Lakdawala M, Bhasker A, Asian Consensus Meeting on Metabolic Surgery (ACMOMS) (2010) Report: Asian consensus meeting on metabolic surgery. Recommendations for the use of bariatric and gastrointestinal metabolic surgery for treatment of obesity and type 2 diabetes mellitus in the Asian population: August 9th and 10th, 2008, Trivandrum, India. Obes Surg 20:929–936
Yang J, Wang C, Cao G, Yang W, Yu S, Zhai H, Pan Y (2015) Long-term effects of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for the treatment of Chinese type 2 diabetes mellitus patients with body mass index 28–35 kg/m2. BMC Surg 15:88
Lakdawala M, Shaikh S, Bandukwala S, Remedios C, Shah M, Bhasker AG (2013) 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 9:370–378
Yin J, Xu L, Mao Z, Zhou X, Zhu Z, Chen X, Sun J, Mu L, Peng C, Qian H, Yang Y (2014) Laparoscopic Roux-en-Y gastric bypass for type 2 diabetes mellitus in nonobese Chinese patients. Surg Laparosc Endosc Percutaneous Tech 24:e200–e206
Park JY, Kim YJ (2015) Prediction of diabetes remission in morbidly obese patients after Roux-en-Y gastric bypass. Obes Surg (Epub ahead of print)
Kim JW, Cheong JH, Hyung WJ, Choi SH, Noh SH (2012) Outcome after gastrectomy in gastric cancer patients with type 2 diabetes. WJG 18:49–54
Rubino F, Gagner M, Gentileschi P, Kini S, Fukuyama S, Feng J, Diamond E (2004) The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg 240:236–242
Korner J, Bessler M, Cirilo LJ, Conwell IM, Daud A, Restuccia NL, Wardlaw SL (2005) Effects of Roux-en-Y-gastric bypass surgery on fasting and postprandial concentrations of plasma ghrelin, peptide YY, and insulin. J Clin Endocrinol Metab 90:359–365
le Roux CW, Aylwin SJ, Batterham RL, Borg CM, Coyle F, Prasad V, Shurey S, Ghatei MA, Patel AG, Bloom SR (2006) Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg 243:108–114
Gallwitz B (2016) Glucagon-like peptide-1 and gastric inhibitory polypeptide: new advances. Curr Opin Endocrinol Diabetes Obes 23:23–27
Zethelius B, Hales CN, Lithell HO, Berne C (2004) Insulin resistance, impaired early insulin response, and insulin propeptides as predictors of the development of type 2 diabetes: a population-based, 7-year follow-up study in 70-year-old men. Diabetes Care 27:1433–1438
Cohen RV, Pinheiro JC, Schiavon CA, Salles JE, Wajchenberg BL, Cummings DE (2012) Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes Care 35:1420–1428
Arterburn D, Schauer DP, Wise RE, Gersin KS, Fischer DR, Selwyn CA Jr, Erisman A, Tsevat J (2009) Change in predicted 10-year cardiovascular risk following laparoscopic Roux-en-Y gastric bypass surgery. Obes Surg 19:184–189
Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I (2007) Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery 142:621–632
Birkmeyer NJ, Dimick JB, Share D, Hawasli A, English WJ, Genaw J, Finks JF, Carlin AM, Birkmeyer JD, Michigan Bariatric Surgery Collaborative (2010) Hospital complication rates with bariatric surgery in Michigan. JAMA 304:435–442
Gong K, Gagner M, Pomp A, Almahmeed T, Bardaro SJ (2008) Micronutrients deficiencies following laparoscopic gastric bypass: recommendations. Obes Surg 18:1062–1066
John S, Hoegerl C (2009) Nutritional deficiencies after gastric bypass surgery. J Am Osteopath Assoc 109:601–604
Acknowledgments
Authors thank Dr. Bin Zheng at the Department of Surgery, University of Alberta for reviewing the paper and provide critical comments during manuscript preparation.
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Ke Gong, Kai Li, Nengwei Zhang, Bin Zhu, Dexiao Du, Dongdong Zhang, Zhen Zhang and Jirun Peng have no conflicts of interest or financial ties to disclose.
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Ke Gong and Kai Li have contributed equally to this study and share first authorship.
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Gong, K., Li, K., Zhang, N. et al. Gastric bypass procedure for type 2 diabetes patients with BMI <28 kg/m2 . Surg Endosc 31, 1172–1179 (2017). https://doi.org/10.1007/s00464-016-5087-3
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DOI: https://doi.org/10.1007/s00464-016-5087-3