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Surgical Endoscopy

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Open Access 01-08-2012

Impact of Roux-en-Y gastric bypass on regulation of diabetes type 2 in morbidly obese patients

Authors: Monika Proczko-Markuszewska, Tomasz Stefaniak, Łukasz Kaska, Jarek Kobiela, Zbigniew Śledziński

Published in: Surgical Endoscopy | Issue 8/2012

Abstract

Background

The idea of surgery as treatment for type 2 diabetes mellitus (T2DM) was established in the US and was based on observation of patients after bariatric surgery. Resolution of T2DM is observed within a few weeks after surgery, in some cases even during hospitalization. The aim of this study was to evaluate the impact of Roux-en-Y gastric bypass (RYGB) on diabetes in morbidly obese patients.

Methods

We present 73 patients with T2DM who underwent laparoscopic RYGB (LRYGB) to treat morbid obesity. In the group of 73 obese patients (mean BMI = 42.3), there were 41 females and 32 males.

Results

Regression of T2DM was observed in 51 patients (69.8%) while hospitalized. In addition, 14 patients’ (19.1%) glycemia and HBA1c stabilized within 12 weeks after surgery (total regression rate of 88.9%).

Conclusion

The ultimate evaluation of this method of treating T2DM is still lacking and requires several years of meticulous clinical studies. Despite that, considering the high cost of life-long conservative therapy of T2DM and its complications and the severe impact T2DM has on quality of life, surgical metabolic intervention may become the most reasonable solution in many cases.

King H, Aubert RE, Herman WH (1998) Global burden of diabetes, 1995–2005: prevalence, numerical estimates, and projections. Diabetes Care 21:1414–1431PubMedCrossRef

World Health Organization (2011) Health experts accept use of HbA1c for diagnosing diabetes. Geneva: WHO Diabetes Unit. Available at www.who.int/diabetes

International Diabetes Federation (2009) Diabetes Atlas, 4th edn. International Diabetes Federation, Brussels, Belgium

Patriti A, Facchiano E, Sanna A, Gullà N, MD, Aisa MC, Annetti C (2004) The enteroinsular axis and the recovery from type 2 diabetes after bariatric surgery. Obes Surg 14:840–848

Rubino F, Marescaux J (2004) Effect of duodenal-jejunal exclusion in non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg 239(1):1–11PubMedCrossRef

Rubino F, Kaplan LM, Schauer PR, Cummings D on behalf of the Diabetes Surgery Summit Delegates (2010) The Diabetes Surgery Summit Consensus Conference. Recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Ann Surg 251:399–405

Rubino F (2008) Is type 2 diabetes an operable intestinal disease? Diabetes Care 31(Suppl 2):S290–S296PubMedCrossRef

Which surgical procedure should be carried out for type 2 diabetes. Presented at the IXth Meeting of the Surgical Continuing Education and XIVth Nutrition, University of Malaga, Malaga, 17–19 February 2010

2nd World Congress on Interventional Therapies for Type 2 Diabetes, New York, 28–30 March, 2011. Available at www.wcidt.org

10.

Bose M, Oliván B, Teixeira J, Pi-Sunyer FX, Laferrère B (2009) Do incretins play a role in the remission of type 2 diabetes after gastric bypass surgery: what are the evidence? Obes Surg 19(2):217–229PubMedCrossRef

11.

Rubino F, Forgione A, Cummings DE, Vix M, Gnuli D, Mingione G, Castagneto M, Marescaux J (2006) The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg 244(5):741–749PubMedCrossRef

12.

National Diabetes Information Clearinghouse (2008) Diagnosis of Diabetes. US Department of Health and Human Services, NIH Publication No. 09–4642

13.

American Diabetes Association (2009) Diagnosis and classification of diabetes mellitus. Diabetes Care 32(1):S62–S66CrossRef

14.

Gautier JF, Fetita S, Sobngwi E, Salaun-Martin C (2005) Biological actions of incretins GIP and GIP-1 and therapeutic perspectives in patients with type 2 diabetes. Diabetes Metab 31:233–242PubMedCrossRef

15.

Mingrone G, Castagneto-Gissey L (2009) Mechanisms of early improvement/resolution of type 2 diabetes after bariatric surgery. Diabetes Metab 35(6):518–523PubMedCrossRef

16.

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(2):236–242PubMedCrossRef

17.

Rubino F, Schauer PR, Kaplan LM, Cummings DE (2010) Metabolic surgery to treat type 2 diabetes: clinical outcomes and mechanisms of action. Annu Rev Med 61:393–411PubMedCrossRef

18.

Laferrere B (2009) Effect of gastric bypass surgery on the incretins. Diabetes Metab 35(6 Pt 2):513–517PubMedCrossRef

19.

Batsis JA, Sarr MG, Collazo-Clavell ML, Thomas RJ, Romero-Corral A, Somers VK, Lopez-Jimenez F (2008) Cardiovascular risk after bariatric surgery for obesity. Am J Cardiol 102(7):930–937PubMedCrossRef

20.

Christou NV, Lieberman M, Sampalis F, Sampalis JS (2008) Bariatric surgery reduces cancer risk in morbidly obese patients. Surg Obes Relat Dis 4(6):691–695PubMedCrossRef

21.

Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ (2009) Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 122(3):248–256PubMedCrossRef

22.

Rubino F, R’bibo SL, del Genio F, Mazumdar M, McGraw TE (2010) Metabolic surgery: the role of the gastrointestinal tract in diabetes mellitus. Rev Endocrinol 6(2):102–109CrossRef

23.

Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, Lystig T, Sullivan M, Bouchard C, Carlsson B, Bengtsson C, Dahlgren S, Gummesson A, Jacobson P, Karlsson J, Lindroos AK, Lönroth H, Näslund I, Olbers T, Stenlöf K, Torgerson J, Ågren G, Carlsson A (2007) Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 357:741–752PubMedCrossRef

24.

Kashyap SR, Bhatt DL, Schauer PR, STAMPEDE Investigators (2010) Bariatric surgery vs. advanced practice medical management in the treatment of type 2 diabetes mellitus: rationale and design of the Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently trial (STAMPEDE). Diabetes Obes Metab 12:452–454PubMedCrossRef

25.

Schauer PR, Burguera B, Ikramudin S, Cottam D, Gourash W, Hamad G, Eid GM, Mattar S, Ramanathan R, Barinas-Mitchel E, Rao H, Kuller L, Kelly D (2003) Effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus. Ann Surg 238(4):467–485PubMed

26.

Maitreyi R, Allard J (2006) Nonalcoholic fatty liver disease: a clinical approach and review. Can J Gastroenterol 20(5):345–349

27.

Geloneze B, Geloneze SR, Fiori C, Stabe C, Tambascia MA, Chaim EA, Astiarraga BD, Pareja JC (2009) Surgery for non-obese type 2 patients: an interventional study with duodenal-jejunal exclusion. Obes Surg 19(8):1077–1083PubMedCrossRef

28.

Fried M, Ribaric G, Buchwald JN, Svacina S, Dolezalova K, Scopinaro N (2010) Metabolic surgery for the treatment of type 2 diabetes in patients with BMI < 35 kg/m²: an integrative review of early studies. Obes Surg 20(6):776–790PubMedCrossRef

29.

Dallegrave Marchesini JC (2007) End-to-side duodeno-jejunostomy with half-and-half biliopancreatic limb for the treatment of type 2 diabetes: a proposal for a simpler technique. Obes Surg 17(1):138–139PubMedCrossRef

30.

Prachand VN, Ward M, Alverdy JC (2010) Duodenal switch provides superior resolution of metabolic comorbidities independent of weight loss in the super-obese (BMI ≥ 50 kg/m2) compared with gastric bypass. J Gastrointest Surg 14(2):211–220PubMedCrossRef

31.

Pories WJ, Swanson MS, MacDonald KG (1995) Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 222:339–350PubMedCrossRef

32.

Hussain A, Mahmood H, El-Hasani S (2009) Can Roux-en-Y gastric bypass provide a lifelong solution for diabetes mellitus? Can J Surg 52(6):E269–E275PubMed

Title: Impact of Roux-en-Y gastric bypass on regulation of diabetes type 2 in morbidly obese patients
Authors: Monika Proczko-Markuszewska
Tomasz Stefaniak
Łukasz Kaska
Jarek Kobiela
Zbigniew Śledziński
Publication date: 01-08-2012
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 8/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-012-2160-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Impact of Roux-en-Y gastric bypass on regulation of diabetes type 2 in morbidly obese patients

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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