Effect of Laparoscopic Mini-Gastric Bypass for Type 2 Diabetes Mellitus: Comparison of BMI >35 and <35 kg/m2
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- Lee, WJ., Wang, W., Lee, YC. et al. J Gastrointest Surg (2008) 12: 945. doi:10.1007/s11605-007-0319-4
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Laparoscopic gastric bypass resulted in significant weight loss and resolution of type 2 diabetes mellitus (T2DM). The current indication for bariatric surgery is mainly applied for patients with body mass index (BMI) >35 kg/m2 with comorbidity status. However, little is known concerning T2DM patients with BMI <35 kg/m2. Recent studies have suggested that T2DM patients with BMI <35 kg/m2 might benefit from gastric bypass surgery.
From Jan 2002 to Dec 2006, 820 patients who underwent laparoscopic mini-gastric bypass were enrolled in a surgically supervised weight loss program. We identified 201 (24.5%) patients who had impaired fasting glucose or T2DM. All the clinical data were prospectively collected and stored. Patients with BMI <35 kg/m2 were compared with those of BMI >35 kg/m2. Successful treatment of T2DM was defined by HbA1C <7.0%, LDL <100 mg/dl, and triglyceride <150 mg/dl.
Among the 201 patients, 44 (21.9%) had BMI <35 kg/m2, and 114 (56.7%) had BMI between 35and 45, 43 (21.4%) had BMI >45 kg/m2. Patients with BMI <35 kg/m2 are significantly older, female predominant, had lower liver enzyme and C-peptide levels than those with BMI >35 kg/m2. The mean total weight loss for the population was 32.1, 33.4, 31.9, and 32.8% (at 1, 2, 3, 5 years after surgery), and percentage to change in BMI was 31.9, 34.2, 32.2, and 29.5% at 1, 2, 3, and 5 years. One year after surgery, fasting plasma glucose returned to normal in 89.5% of BMI <35 kg/m2 T2DM and 98.5% of BMI >35 kg/m2 patients (p = 0.087). The treatment goal of T2DM (HbA1C <7.0%, LDL <150 mg/dl and triglyceride <150 mg/dl) was met in 76.5% of BMI <35 kg/m2 and 92.4% of BMI >350 kg/m2 (p = 0.059).
Laparoscopic gastric bypass resulted in significant and sustained weight loss with successful treatment of T2DM up to 87.1%. Despite a slightly lower response rate of T2DM treatment, patients with BMI <35 still had an acceptable DM resolution, and this treatment option can be offered to this group of patients.