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Published in: Obesity Surgery 7/2014

01-07-2014 | Original Contributions

Short-Term Outcomes of Laparoscopic Single Anastomosis Gastric Bypass (LSAGB) for the Treatment of Type 2 Diabetes in Lower BMI (<30 kg/m2) Patients

Authors: Myung Jin Kim, Kyung Yul Hur

Published in: Obesity Surgery | Issue 7/2014

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Abstract

Background

Bariatric surgery is an efficient procedure for remission of type 2 diabetes (T2DM) in morbid obesity. However, in Asian countries, mean body mass index (BMI) of T2DM patients is about 25 kg/m2. Various data on patients undergoing gastric bypass surgery showed that control of T2DM after surgery occurs rapidly and somewhat independent to weight loss. We hypothesized that in non-obese patients with T2DM, the glycemic control would be achieved as a consequence of gastric bypass surgery.

Methods

From September 2009, the 172 patients have had laparoscopic single anastomosis gastric bypass (LSAGB) surgery. Among them, 107 patients have been followed up more than 1 year. We analyzed the dataset of these patients. Values related to diabetes were measured before and 1, 2, and 3 years after the surgery.

Results

The mean BMI decreased during the first year after the surgery but plateaued after that. The mean glycosylated hemoglobin level decreased continuously. The mean fasting and postglucose loading plasma glucose level also decreased.

Conclusion

After LSAGB surgery in non-obese T2DM patients, the control of T2DM was possible safely and effectively. However, longer follow-up with matched control group is essential.
Literature
1.
go back to reference Zimmer P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001;414:782–87.CrossRef Zimmer P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001;414:782–87.CrossRef
2.
go back to reference Guh DP, Zhang W, Bansback N, et al. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009;9:88.PubMedCentralPubMedCrossRef Guh DP, Zhang W, Bansback N, et al. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009;9:88.PubMedCentralPubMedCrossRef
4.
go back to reference Chan JM, Rimm EB, Colditz GA, et al. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care. 1994;17:961–9.PubMedCrossRef Chan JM, Rimm EB, Colditz GA, et al. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care. 1994;17:961–9.PubMedCrossRef
5.
go back to reference Colditz GA, Willett WC, Rotnitzky A, et al. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med. 1995;122:481–6.PubMedCrossRef Colditz GA, Willett WC, Rotnitzky A, et al. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med. 1995;122:481–6.PubMedCrossRef
6.
go back to reference Ambady R, Ronald Ching WM, Chamukuttau S. Diabetes in Asia. Lancet. 2010;375:408–18.CrossRef Ambady R, Ronald Ching WM, Chamukuttau S. Diabetes in Asia. Lancet. 2010;375:408–18.CrossRef
7.
go back to reference Juliana CN, Vasanti M, Weiping J, et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009;301:2129–37.CrossRef Juliana CN, Vasanti M, Weiping J, et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009;301:2129–37.CrossRef
8.
go back to reference Oh JY, Hong YS, Sung YA, et al. Prevalence and factor analysis of metabolic syndrome in an urban Korean population. Diabetes Care. 2004;27:2027–32.PubMedCrossRef Oh JY, Hong YS, Sung YA, et al. Prevalence and factor analysis of metabolic syndrome in an urban Korean population. Diabetes Care. 2004;27:2027–32.PubMedCrossRef
9.
go back to reference Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRef Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRef
10.
go back to reference Mingrone G, DeGaetano A, Greco AV, et al. Reversibility of insulin resistance in obese diabetic patients: role of plasma lipids. Diabetologia. 1997;40:599–605.PubMedCrossRef Mingrone G, DeGaetano A, Greco AV, et al. Reversibility of insulin resistance in obese diabetic patients: role of plasma lipids. Diabetologia. 1997;40:599–605.PubMedCrossRef
12.
go back to reference Rutledge R. The mini-gastric bypass: experience with the first 1274 cases. Obes Surg. 2001;11:276–80.PubMedCrossRef Rutledge R. The mini-gastric bypass: experience with the first 1274 cases. Obes Surg. 2001;11:276–80.PubMedCrossRef
13.
go back to reference Pories WJ, Albrecht RJ. Etiology of type 2 diabetes mellitus: role of the foregut. World J Surg. 2001;25:527–31.PubMedCrossRef Pories WJ, Albrecht RJ. Etiology of type 2 diabetes mellitus: role of the foregut. World J Surg. 2001;25:527–31.PubMedCrossRef
15.
go back to reference Scott EG, Frank LG, Stanley K. Effects of obesity surgery on non-insulin-dependent diabetes mellitus. Arch Surg. 2002;137:1109–17.CrossRef Scott EG, Frank LG, Stanley K. Effects of obesity surgery on non-insulin-dependent diabetes mellitus. Arch Surg. 2002;137:1109–17.CrossRef
17.
go back to reference Scopinaro N, Marinari G, Camerini GB, et al. Specific effects of biliopancreatic diversion on the major components of metabolic syndrome: a long-term follow-up study. Diabetes Care. 2005;28:2406–11.PubMedCrossRef Scopinaro N, Marinari G, Camerini GB, et al. Specific effects of biliopancreatic diversion on the major components of metabolic syndrome: a long-term follow-up study. Diabetes Care. 2005;28:2406–11.PubMedCrossRef
18.
19.
go back to reference Bose M, Olivan B, Teixeira J, et al. Do incretins play a role in the remission of type 2 diabetes after gastric bypass surgery: what are the evidence? Obes Surg. 2009;19:217–29.PubMedCentralPubMedCrossRef Bose M, Olivan B, Teixeira J, et al. Do incretins play a role in the remission of type 2 diabetes after gastric bypass surgery: what are the evidence? Obes Surg. 2009;19:217–29.PubMedCentralPubMedCrossRef
20.
go back to reference Padwal RS, Gabr RQ, Sharma AM, et al. Effect of gastric bypass surgery on the absorption and bioavailability of metformin. Diabetes Care. 2011;34:1295–300.PubMedCentralPubMedCrossRef Padwal RS, Gabr RQ, Sharma AM, et al. Effect of gastric bypass surgery on the absorption and bioavailability of metformin. Diabetes Care. 2011;34:1295–300.PubMedCentralPubMedCrossRef
21.
go back to reference Patti ME, Houten SM, Bianco A, et al. Serum bile acids are higher in humans with prior gastric bypass: potential contribution to improved glucose and lipid metabolism. Obesity. 2009;17:1671–7.PubMedCrossRef Patti ME, Houten SM, Bianco A, et al. Serum bile acids are higher in humans with prior gastric bypass: potential contribution to improved glucose and lipid metabolism. Obesity. 2009;17:1671–7.PubMedCrossRef
22.
go back to reference Laferrere B, McGinty J, Heshka S, et al. Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes. Diabetes Care. 2007;30:1709–16.PubMedCentralPubMedCrossRef Laferrere B, McGinty J, Heshka S, et al. Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes. Diabetes Care. 2007;30:1709–16.PubMedCentralPubMedCrossRef
23.
go back to reference Rubino F, R’bibo SL, del Genio F, et al. Metabolic surgery: the role of the gastrointestinal tract in diabetes mellitus. Nat Rev Endocrinol. 2010;6:102–9.PubMedCentralPubMedCrossRef Rubino F, R’bibo SL, del Genio F, et al. Metabolic surgery: the role of the gastrointestinal tract in diabetes mellitus. Nat Rev Endocrinol. 2010;6:102–9.PubMedCentralPubMedCrossRef
24.
go back to reference Rubino F, Forgione A, Cummings DE, et al. 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. 2006;244:741–9.PubMedCentralPubMedCrossRef Rubino F, Forgione A, Cummings DE, et al. 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. 2006;244:741–9.PubMedCentralPubMedCrossRef
25.
go back to reference Garcia-Caballero M, Valle M, Martinez-Moreno JM, et al. Resolution of diabetes mellitus and metabolic syndrome in normal weight 24-29 BMI patients with one anastomosis gastric bypass. Nutr Hosp. 2012;27:623–31.PubMed Garcia-Caballero M, Valle M, Martinez-Moreno JM, et al. Resolution of diabetes mellitus and metabolic syndrome in normal weight 24-29 BMI patients with one anastomosis gastric bypass. Nutr Hosp. 2012;27:623–31.PubMed
26.
go back to reference Rubino F, Gagner M, Gentileschi P, et al. The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg. 2004;240:236–42.PubMedCentralPubMedCrossRef Rubino F, Gagner M, Gentileschi P, et al. The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg. 2004;240:236–42.PubMedCentralPubMedCrossRef
27.
29.
go back to reference Perley MJ, Kipnis DM. Plasma insulin responses to oral and intravenous glucose: studies in normal and diabetic subjects. J Clin Invest. 1967;46:1954–62.PubMedCentralPubMedCrossRef Perley MJ, Kipnis DM. Plasma insulin responses to oral and intravenous glucose: studies in normal and diabetic subjects. J Clin Invest. 1967;46:1954–62.PubMedCentralPubMedCrossRef
30.
go back to reference Preitner F, Ibberson M, Franglin I, et al. Gluco-incretins control insulin secretion at multiple levels as revealed in mice lacking GLP-1 and GIP receptors. J Clin Invest. 2004;113:635–45.PubMedCentralPubMedCrossRef Preitner F, Ibberson M, Franglin I, et al. Gluco-incretins control insulin secretion at multiple levels as revealed in mice lacking GLP-1 and GIP receptors. J Clin Invest. 2004;113:635–45.PubMedCentralPubMedCrossRef
31.
go back to reference Timothy JK, Joel FH. The glucagon-like peptides. Endocr Rev. 1999;20:876–913.CrossRef Timothy JK, Joel FH. The glucagon-like peptides. Endocr Rev. 1999;20:876–913.CrossRef
32.
go back to reference Fiona MG, Leanne W, Anna KS, et al. A novel glucose-sensing mechanism contributing to glucagon-like peptide-1 secretion from the GLUTag cell line. Diabetes. 2003;52:1147–54.CrossRef Fiona MG, Leanne W, Anna KS, et al. A novel glucose-sensing mechanism contributing to glucagon-like peptide-1 secretion from the GLUTag cell line. Diabetes. 2003;52:1147–54.CrossRef
33.
go back to reference Juris JM, Michael AN, Wolfgang ES, et al. Gastric inhibitory polypeptide: the neglected incretin revisited. Regul Pept. 2002;107:1–13.CrossRef Juris JM, Michael AN, Wolfgang ES, et al. Gastric inhibitory polypeptide: the neglected incretin revisited. Regul Pept. 2002;107:1–13.CrossRef
34.
go back to reference Creutzfeldt W. The entero-insular axis in type 2 diabetes—incretins as therapeutic agents. Exp Clin Endocrinol Diabetes. 2001;109(Suppl2):S288–303.PubMedCrossRef Creutzfeldt W. The entero-insular axis in type 2 diabetes—incretins as therapeutic agents. Exp Clin Endocrinol Diabetes. 2001;109(Suppl2):S288–303.PubMedCrossRef
35.
go back to reference Santoro S, Castro LC, Velhote MC, et al. Sleeve gastrectomy with transit bipartition. A potent intervention for metabolic syndrome and obesity. Ann Surg. 2012;256:104–10.PubMedCrossRef Santoro S, Castro LC, Velhote MC, et al. Sleeve gastrectomy with transit bipartition. A potent intervention for metabolic syndrome and obesity. Ann Surg. 2012;256:104–10.PubMedCrossRef
36.
go back to reference Vilsboll T, Krarup T, Sonne J, et al. Incretin secretion in relation to meal size and body weight in healthy subjects and people with type 1 and type 2 diabetes mellitus. J Clin Endocrinol Metab. 2003;88:2706–13.PubMedCrossRef Vilsboll T, Krarup T, Sonne J, et al. Incretin secretion in relation to meal size and body weight in healthy subjects and people with type 1 and type 2 diabetes mellitus. J Clin Endocrinol Metab. 2003;88:2706–13.PubMedCrossRef
37.
go back to reference Vilsboll T, Krarup T, Deacon CF, et al. Reduced postprandial concentrations of intact biologically active glucagon-like peptide 1 in type 2 diabetic patients. Diabetes. 2001;50:609–13.PubMedCrossRef Vilsboll T, Krarup T, Deacon CF, et al. Reduced postprandial concentrations of intact biologically active glucagon-like peptide 1 in type 2 diabetic patients. Diabetes. 2001;50:609–13.PubMedCrossRef
38.
go back to reference Fetner R, McGinty J, Russell C, et al. Incretins, diabetes, and bariatric surgery: a review. Surg Obes Relat Dis. 2005;1:589–98.PubMedCrossRef Fetner R, McGinty J, Russell C, et al. Incretins, diabetes, and bariatric surgery: a review. Surg Obes Relat Dis. 2005;1:589–98.PubMedCrossRef
39.
go back to reference Wang W, Wei PL, Lee YC, et al. Short-term results of laparoscopic mini-gastric bypass. Obes Surg. 2005;15(5):648–54.PubMedCrossRef Wang W, Wei PL, Lee YC, et al. Short-term results of laparoscopic mini-gastric bypass. Obes Surg. 2005;15(5):648–54.PubMedCrossRef
40.
go back to reference Rutledge R, Walsh TR. Continued excellent results with the mini-gastric bypass: six-year study in 2,410 patients. Obes Surg. 2005;15(9):1304–8.PubMedCrossRef Rutledge R, Walsh TR. Continued excellent results with the mini-gastric bypass: six-year study in 2,410 patients. Obes Surg. 2005;15(9):1304–8.PubMedCrossRef
41.
go back to reference Piazza L, Ferrara F, Leanza S, et al. A laparoscopic mini-gastric bypass: short-term single-institute experience. Updat Surg. 2011;63(4):239–42.CrossRef Piazza L, Ferrara F, Leanza S, et al. A laparoscopic mini-gastric bypass: short-term single-institute experience. Updat Surg. 2011;63(4):239–42.CrossRef
42.
go back to reference Noun R, Skaff J, Riachi E, et al. One thousand consecutive mini-gastric bypass: short- and long-term outcome. Obes Surg. 2012;22(5):697–703.PubMedCrossRef Noun R, Skaff J, Riachi E, et al. One thousand consecutive mini-gastric bypass: short- and long-term outcome. Obes Surg. 2012;22(5):697–703.PubMedCrossRef
43.
go back to reference Lee WJ, Wang W, Lee YC, et al. Laparoscopic mini-gastric bypass: experience with tailored bypass limb according to body weight. Obes Surg. 2008;18(3):294–9.PubMedCrossRef Lee WJ, Wang W, Lee YC, et al. Laparoscopic mini-gastric bypass: experience with tailored bypass limb according to body weight. Obes Surg. 2008;18(3):294–9.PubMedCrossRef
44.
go back to reference Dang H, Arias E, Szomstein S, et al. Laparoscopic conversion of distal mini-gastric bypass to proximal Roux-en-Y gastric bypass for malnutrition: case report and review of the literature. SORD. 2009;5:383–6. Dang H, Arias E, Szomstein S, et al. Laparoscopic conversion of distal mini-gastric bypass to proximal Roux-en-Y gastric bypass for malnutrition: case report and review of the literature. SORD. 2009;5:383–6.
45.
go back to reference Johnson WH, Fernanadez AZ, Farrell TM, et al. Surgical revision of loop gastric bypass procedure: multicenter review of complications and conversions to Roux-en-Y gastric bypass. SORD. 2007;3:37–41. Johnson WH, Fernanadez AZ, Farrell TM, et al. Surgical revision of loop gastric bypass procedure: multicenter review of complications and conversions to Roux-en-Y gastric bypass. SORD. 2007;3:37–41.
46.
go back to reference Azagury DE, Abu Dayyeh BK, Greenwalt IT, et al. Marginal ulceration after Roux-en-Y gastric bypass surgery: characteristics, risk factors, treatment, and outcomes. Endoscopy. 2011;43:950–4.PubMedCrossRef Azagury DE, Abu Dayyeh BK, Greenwalt IT, et al. Marginal ulceration after Roux-en-Y gastric bypass surgery: characteristics, risk factors, treatment, and outcomes. Endoscopy. 2011;43:950–4.PubMedCrossRef
47.
go back to reference Kim YG, Hahn S, Oh TJ, et al. Differences in the glucose-lowering efficacy of dipeptidyl peptidase-4 inhibitors between Asians and non-Asians: a systematic review and meta-analysis. Diabetologia. 2013;56:696–708.PubMedCrossRef Kim YG, Hahn S, Oh TJ, et al. Differences in the glucose-lowering efficacy of dipeptidyl peptidase-4 inhibitors between Asians and non-Asians: a systematic review and meta-analysis. Diabetologia. 2013;56:696–708.PubMedCrossRef
Metadata
Title
Short-Term Outcomes of Laparoscopic Single Anastomosis Gastric Bypass (LSAGB) for the Treatment of Type 2 Diabetes in Lower BMI (<30 kg/m2) Patients
Authors
Myung Jin Kim
Kyung Yul Hur
Publication date
01-07-2014
Publisher
Springer US
Published in
Obesity Surgery / Issue 7/2014
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-014-1202-5

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