Gastrointestinal Metabolic Surgery for the Treatment of Diabetic Patients: A Multi-Institutional International Study
- 948 Downloads
Gastrointestinal metabolic surgery has been proposed for the treatment of not well-controlled type 2 diabetes mellitus (T2DM) patients with a body mass index (BMI) <35 kg/m2. This study aims to describe recent experience with surgical treatment of T2DM in Asian centers.
Patients aged 20 to 70 years with not well-controlled T2DM [glycated hemoglobin (HbA1C) >7.0%] and BMI < 35 kg/m2 were included at five institutes between 2007 and 2010. The end point is T2DM remission, defined by fasting plasma glucose <110 mg/dl and HbA1C <6.0%.
Of the 200 patients, 172 (86%) underwent gastric bypass, 24 (12%) underwent sleeve gastrectomy, and the other 4 underwent adjustable banding. Laparoscopic access was used in all the patients. Gender (66.5% female), age (mean 45.0 ± 10.8), and HbA1C (mean 9.3 ± 1.9%) did not differ between the procedure among the groups. Until now, 87 patients had 1-year data. One year after surgery, the mean BMI decreased from 28.5 ± 3.0 to 23.4 ± 2.3 kg/m2 and HbA1C decreased to 6.3 ± 0.5%. Remission of T2DM was achieved in 72.4% of the patients. Patients with a diabetes duration of <5 years had a better diabetes remission rate than patients with duration of diabetes >5 years (90.3% vs. 57.1%; p = 0.006). Patients with BMI > 30 kg/m2 had a better diabetes remission rate than those with BMI < 30 kg/m2 (78.7% vs. 62.5%; p = 0.027). Individuals who underwent gastric bypass loss more weight and had a higher diabetes remission rate than individuals who underwent restrictive-type procedures. Multivariate analysis confirmed that the duration of diabetes and the type of surgery predict the diabetes remission. No mortalities were reported and two (1.0%) patients had major morbidities.
Gastrointestinal metabolic surgery is an effective treatment for not well-controlled T2DM treatment. Diabetes remission is significantly higher in those with duration of diabetes less than 5 years and BMI > 30 kg/m2.
KeywordsGastrointestinal metabolic surgery Type 2 diabetes mellitus
This work was supported by the grant from Ming-Shen General Hospital (99-A-01).
- 12.Lee Wj, Lee YC, Ser KH, Chen JC, Chen SC. Effect of diabetes resolution after bariatric surgery in Asian patients. World J Surg 2009;18:1119–1125.Google Scholar
- 18.Demaria EJ, Winegar DA, Pate VW, et al. 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 database. Ann Surg 2010;252:559–567.PubMedGoogle Scholar