Obesity Surgery

, Volume 25, Issue 8, pp 1371–1379 | Cite as

Gastro-intestinal Quality of Life After Metabolic Surgery for the Treatment of Type 2 Diabetes Mellitus

  • Wei-Jei LeeEmail author
  • Ming-Hsien Lee
  • Po-Jui Yu
  • Jih-Hua Wei
  • Keong Chong
  • Shu-Chun Chen
  • Abdullah Almulaifi
  • Yi-Chih Lee
Original Contributions



Emerging evidence has shown that bariatric/metabolic surgery ameliorates type 2 diabetes (T2DM) in mildly obese patients (BMI < 35 kg/m2) but long-term data is inadequate. We investigated the change of the quality of life after metabolic surgery in not well-controlled T2DM patients with BMI < 35 kg/m2.


The quality of life was measured by the gastrointestinal quality of life index (GIQLI), a 36-item questionnaire divided into three domains of general health and one domain of specific gastro-intestinal symptoms, administered before operation, at 3, 6, and 12 months after surgery. A control group matched in age, gender, and BMI was recruited for comparison.


A total of 86 patients were enrolled, and the preoperative BMI and HbA1C (mean ± SD) were 30.7 ± 2.8 kg/m2 and 9.3 ± 2.1 %, respectively. At 1 year after surgery, the BMI and HbA1C were 24.3 ± 2.3 kg/m2 and 6.2 ± 1.1 %, respectively. There was a significantly improvement in all of the measures of glucose metabolism. Complete remission (HbA1C < 6.0 %) was achieved in 56 subjects (65 %) at 12 months. The GIQLI score was significantly impaired in T2DM patients before surgery compared with the control group. The GIQLI score significantly increased from 109.2 ± 20.0 to 116.1 ± 14.2 points 1 year after surgery. The patients had improvement in the three domains of general health (social, physical, and emotional function) without a difference with the normal control but deteriorated in the domain of specific symptoms. Most of the patients experienced symptoms including abdominal pain, bloating, flatulence, belching, abdominal noise, regurgitation, dysphagia, slow eating speed, nausea, bowel urgency, and incontinence after metabolic syndrome.


Health-related QOL improved dramatically after metabolic surgery for not well-controlled T2DM patients with BMI < 35 kg/m2, but patients might develop specific gastro-intestinal symptoms after surgery.


Type 2 diabetes Metabolic surgery Quality of life Gastro-intestinal symptoms 


Conflict of Interest

All authors declare that they have no conflict of interest, and the study has not been supported by any grants.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human and Animal Rights

For this type of study, formal consent is not required.


  1. 1.
    Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world—a growing challenge. N Engl J Med. 2007;356:213–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Chan JC, Malik V, Jia W, et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009;301(20):2129–40.PubMedCrossRefGoogle Scholar
  3. 3.
    Stark Casagrande S, Fradkin JE, Saydah SH, et al. The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1998–2010. Diabetes Care. 2013;36(8):2271–9.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Xu Y, Wang L, He J, et al. Prevalence and control of diabetes in Chinese adults. JAMA. 2013;310(9):948–58.PubMedCrossRefGoogle Scholar
  5. 5.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRefGoogle Scholar
  6. 6.
    Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. NEJM. 2004;351:2683–93.PubMedCrossRefGoogle Scholar
  7. 7.
    Dixon J, O’Brien PE. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabete Care. 2002;25:358–63.CrossRefGoogle Scholar
  8. 8.
    Karlsson J, Taft C, Ryden A, et al. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes (Lond). 2007;31:1248–61.CrossRefGoogle Scholar
  9. 9.
    Chang CY, Huang CK, Chang YY, et al. Prospective study of health-related quality of life after Roux-en-Y bypass surgery for morbid obesity. Br J Surg. 2010;97:1541–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Lee WJ, Wang W, Lee YC, et al. Effects of laparoscopic mini-gastric bypass for type 2 diabetes mellitus: comparison of BMI >35 and <35 kg/m2. J Gastrointest Surg. 2008;12:945–52.PubMedCrossRefGoogle Scholar
  11. 11.
    Rubino F, Kaplan LM, Schauer PR, et al. The Diabetes Surgery Summit Consensus Conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Ann Surg. 2010;251:399–405.PubMedCrossRefGoogle Scholar
  12. 12.
    Dixon JB, OBrien PE. Play fair I. et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: I ramdomized controlled trial. JAMA 2008 299:316–323Google Scholar
  13. 13.
    Schauer PR, Kashyap S, Wolski K. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1567–76.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia. The Diabetes Surgery Study randomized clinical trial. JAMA. 2013;309:2240–9.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Maggard-Gibbons M, Maglione M, Livhits M, et al. Bariatric surgery for weight loss and glycemic control in nonmorbidly obese adults with diabetes: a systematic review. JAMA. 2013;309(21):2250–61.PubMedCrossRefGoogle Scholar
  16. 16.
    Lebovitz HE. Metabolic surgery for type 2 diabetes with BMI <35 kg/m2. An endocrinologist’s perspective. Obes Surg. 2013;23:800–8.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Sjostrom L, Narbro K, Sjostrom D, et al. Effect of bariatric surgery on mortality in Swedish obese subjects. NEJM. 2007;357:741–52.PubMedCrossRefGoogle Scholar
  18. 18.
    Diagnosis and classification of diabetes mellitus. Diabetes Care 2010; 33 Suppl 1:S62-9.Google Scholar
  19. 19.
    Lee WJ, Yu PY, Wang W, et al. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Ann Surg. 2005;242:20–8.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Ser K-H, Lee W-J, Lee Y-C, et al. Experience in laparoscopic sleeve gastrectomy for morbid obese Taiwanese: staple-line reinforcement is important for preventing leakage. Surg Endosc. 2010;24:2253–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Espasch E, Williams JL, Wood-Dauphinee S. Gastrointestinal Quality of Life Index: development validation and application of new instrument. Br J Surg. 1995;82:216–22.CrossRefGoogle Scholar
  22. 22.
    Jentschura D, Winkler M, Strohmeier N, et al. Quality-of-life after curative surgery for gastric cancer: a comparison between total gastrectomy and subtotal gastric resection. Hepatogastroenterology. 1997;44:1137–42.PubMedGoogle Scholar
  23. 23.
    Slim K, Bousquet J, Kwiatkowski F. Quality of life before and after laparoscopic fundoplication. Am J Surg. 2001;180:41–5.CrossRefGoogle Scholar
  24. 24.
    Decker G, Borie F, Bouamrirene D. Gastrointestinal quality of life before and after laparoscopic Heller myotomy with partial posterior fundoplication. Ann Surg. 2002;236:750–8.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Lee WJ, Yu PJ, Wang W, et al. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity. Ann Surg. 2005;242:20–8.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Lee WJ, Wang W, Yu PJ, et al. Gastrointestinal quality of life following laparoscopic adjustable gastric banding in Asia. Obes Surg. 2006;16:586–91.PubMedCrossRefGoogle Scholar
  27. 27.
    Peterli R, Wolnerhanssen B, Peters T, et al. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg. 2009;250:234–41.PubMedCrossRefGoogle Scholar
  28. 28.
    Overs SE, Freeman RA, Zarshenas N, et al. Food tolerance and gastrointestinal quality of life following three bariatric procedures: adjustable gastric banding, Roux-en-Y gastric bypass, and sleeve gastrectomy. Obes Surg. 2012;22:536–43.PubMedCrossRefGoogle Scholar
  29. 29.
    Lee YC, Liew PL, Lee WJ, et al. Gastrointestinal quality of life following bariatric surgery in Asian patients. Hepatogastroenterology. 2013;60:759–61.PubMedGoogle Scholar
  30. 30.
    Yu PJ, Tsou JJ, Lee WJ, et al. Impairment of gastrointestinal quality of life in severely obese patients. World J Gastroenterol. 2014;20:7027–33.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Buse JB, Laughlin S, Caprio S, et al. How do we define cure of diabetes? Diabetes Care. 2009;32:2133–5.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Wandell PE, Brorsson B, Aberg H. Quality of life in diabetic patients registered with primary health care services in Sweden. Scand J Prim Health Care. 1997;15:97–102.PubMedCrossRefGoogle Scholar
  33. 33.
    Rubin RR, Peyrot M. Quality of life and diabetes. Diabetes Metab Rev. 1999;15(3):205–18.CrossRefGoogle Scholar
  34. 34.
    McEwen LN, Kim C, Haan MN, et al. Are health-related quality-of-life and self-rated health associated with mortality? Insights from Translating Research Into Action for Diabetes (TRIAD). Prim Care Diabetes. 2009;3(1):37–42.PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Landman GW, van Hateren KJ, Kleefstra N, et al. Health-related quality of life and mortality in a general and elderly population of patients with type 2 diabetes (ZODIAC-18). Diabetes Care. 2010;33(11):2378–82.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Kleefstra LGW, Houweling ST, et al. Prediction of mortality in type 2 diabetes from health-related quality of life (ZODIAC-4). Diabetes Care. 2008;31(5):932–3.PubMedCrossRefGoogle Scholar
  37. 37.
    Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes. N Engl J Med. 2014. doi: 10.1056/NEJMoa1401329.
  38. 38.
    Jacobson AM, de Groot M, Samson JA. The evaluation of two measures of quality of life in patients with type I and type II diabetes. Diabetes Care. 1994;17(4):267–74.PubMedCrossRefGoogle Scholar
  39. 39.
    Treif PM, Grant W, Elbert K, et al. A comparison of global versus disease-specific quality-of-life measures in patients with NIDDM. Diabetes Care. 1997;20:299–305.CrossRefGoogle Scholar
  40. 40.
    Ahroni JH, Boyko EJ, Davignon DR, et al. The health and functional status of veterans with diabetes. Diabetes Care. 1994;17:318–21.PubMedCrossRefGoogle Scholar
  41. 41.
    Wuslin LR, Jacobson AM, Rand LI. Psychosocial aspects of diabetic retinopathy. Diabetes are. 1998;21:1699–706.Google Scholar
  42. 42.
    Hanestand BR, Gruce M. To maintain quality of life and satisfactory metabolic control in type II diabetes patients. Qual Life Res. 1995;4:436–7.Google Scholar
  43. 43.
    Wikblad K, Leksell J, Wibell L. Health-related quality of life in relationship to metabolic control and late complication in patients with insulin dependent diabetes mellitus. Quality of life Res. 1996;5:123–30.CrossRefGoogle Scholar
  44. 44.
    Peterson T, Lee P, Young B, et al. Well-being and treatment satisfaction in older people with diabetes. Diabetes Care. 1998;21:930–5.CrossRefGoogle Scholar
  45. 45.
    Keinanen-Kiukaanniemi S, Ohinmaa A, Pajunpaa H, et al. Health iabet Med. 1996;13:382–8.Google Scholar
  46. 46.
    Glasgow RE, Ruggero L, Eakin EG, et al. Quality of life and association characteristics in a large national sample of adults with diabetes. Diabetes Care. 1997;20:562–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Gilden JL, Casia C, Hendryx M, et al. Effects of self-monitoring of blood glucose on quality of life in elderly diabetic patients. J Am Geriatr Soc. 1990;38:511–5.PubMedCrossRefGoogle Scholar
  48. 48.
    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;146:143–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Jullig M, Yip S, Xu A, et al. Low fetulin-A, retinol binding 4 and several metabolites after gastric bypass compared to sleeve gastrectomy in patients with type 2 diabetes. PLoS. 2014;9:e96489.CrossRefGoogle Scholar
  50. 50.
    Peterli R, Borbely Y, Ker B, et al. Early results of the Swiss multicentre bypass or sleeve study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg. 2013;258:690–5.PubMedCentralPubMedCrossRefGoogle Scholar
  51. 51.
    Lee WJ, Ser KH, Chong K, et al. Laparoscopic sleeve gastrectomy for diabetes treatment in non-morbidly obese patients: efficacy and change of insulin secretion. Surgery. 2010;147:664–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Wei-Jei Lee
    • 1
    Email author
  • Ming-Hsien Lee
    • 2
  • Po-Jui Yu
    • 3
  • Jih-Hua Wei
    • 4
  • Keong Chong
    • 4
  • Shu-Chun Chen
    • 1
  • Abdullah Almulaifi
    • 1
  • Yi-Chih Lee
    • 5
  1. 1.Department of SurgeryMin-Sheng General HospitalTaipeiTaiwan
  2. 2.Department of SurgeryChina HospitalTaichungTaiwan
  3. 3.Department of NursingNational Taiwan UniversityTaipeiTaiwan
  4. 4.Department of Internal MedicineMin-Sheng General HospitalTaipeiTaiwan
  5. 5.Department of International BusinessChien Hsin University of Science and TechnologyTaipeiTaiwan

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