Skip to main content
Top
Published in: Surgical Endoscopy 7/2016

01-07-2016

Gastric bypass significantly improves quality of life in morbidly obese patients with type 2 diabetes

Authors: Philip Omotosho, Alessandro Mor, Prapimporn Chattranukulchai Shantavasinkul, Leonor Corsino, Alfonso Torquati

Published in: Surgical Endoscopy | Issue 7/2016

Login to get access

Abstract

Objective

To evaluate the impact of Roux-en-Y gastric bypass (RYGB) on quality of life in obese diabetic patients compared to standard medical therapy for type 2 diabetes mellitus.

Methods

We prospectively studied two matched obese populations with type 2 diabetes. Thirty patients underwent laparoscopic RYGB and 31 received standard medical therapy combined with a diabetes support and education program (DSE), consisting of educational sessions on diet and exercise. Groups were matched by age, gender, weight, glucostatic parameters, and use of glucose-lowering medications (oral agents and insulin therapy). Health-related quality of life (HRQOL) was assessed using the normalized SF-36 questionnaire, and data were collected at baseline and at 12-month follow-up.

Results

Diabetic patients who underwent RYGB experienced a statistically significant increase in their overall HRQOL. However, the role-physical and mental health domains increased but did not reach statistical significance. Diabetic patients in the medical therapy and DSE group did not show any significant increase in HRQOL. The between-group differences for the HRQOL changes from baseline were significant, other than for role-physical and mental health domains. Percentage changes in glucostatic parameters, discontinuation of glucose-lowering medications, and T2DM remission were not found to predict the percentage change in SF-36 scores at 12 months after RYGB.

Conclusions

For the first time, with a prospective matched control study, we demonstrate a significant improvement in HRQOL in obese diabetic patients who underwent RYGB, but not in those who were offered standard medical therapy and DSE.
Literature
1.
go back to reference Kelly T, Yang W, Chen CS, Reynolds K, He J (2008) Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond) 32:1431–1437CrossRef Kelly T, Yang W, Chen CS, Reynolds K, He J (2008) Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond) 32:1431–1437CrossRef
2.
go back to reference Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Leccesi L, Nanni G, Pomp A, Castagneto M, Ghirlanda G, Rubino F (2012) Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med 366:1577–1585CrossRefPubMed Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Leccesi L, Nanni G, Pomp A, Castagneto M, Ghirlanda G, Rubino F (2012) Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med 366:1577–1585CrossRefPubMed
3.
go back to reference Hofso D, Jenssen T, Hager H, Roislien J, Hjelmesaeth J (2010) Fasting plasma glucose in the screening for type 2 diabetes in morbidly obese subjects. Obes Surg 20:302–307CrossRefPubMed Hofso D, Jenssen T, Hager H, Roislien J, Hjelmesaeth J (2010) Fasting plasma glucose in the screening for type 2 diabetes in morbidly obese subjects. Obes Surg 20:302–307CrossRefPubMed
4.
go back to reference Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, Marks JS (2003) Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 289:76–79CrossRefPubMed Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, Marks JS (2003) Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 289:76–79CrossRefPubMed
5.
go back to reference Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737CrossRefPubMed Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737CrossRefPubMed
6.
go back to reference Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I (2009) Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 122(248–256):e245 Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I (2009) Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 122(248–256):e245
7.
go back to reference Colquitt JL, Picot J, Loveman E, Clegg AJ (2009) Surgery for obesity. Cochrane Database Syst Rev 15(2):CD003641 Colquitt JL, Picot J, Loveman E, Clegg AJ (2009) Surgery for obesity. Cochrane Database Syst Rev 15(2):CD003641
8.
go back to reference Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, Thomas S, Abood B, Nissen SE, Bhatt DL (2012) Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 366:1567–1576CrossRefPubMedPubMedCentral Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, Thomas S, Abood B, Nissen SE, Bhatt DL (2012) Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 366:1567–1576CrossRefPubMedPubMedCentral
9.
go back to reference The WHOQOL group (1998) The World Health Organization Quality of Life Assessment (WHOQOL): development and general psychometric properties. Soc Sci Med 46(1982):1569–1585CrossRef The WHOQOL group (1998) The World Health Organization Quality of Life Assessment (WHOQOL): development and general psychometric properties. Soc Sci Med 46(1982):1569–1585CrossRef
10.
go back to reference Kral JG, Sjostrom LV, Sullivan MB (1992) Assessment of quality of life before and after surgery for severe obesity. Am J Clin Nutr 55:611s–614sPubMed Kral JG, Sjostrom LV, Sullivan MB (1992) Assessment of quality of life before and after surgery for severe obesity. Am J Clin Nutr 55:611s–614sPubMed
11.
go back to reference Ware JE, Kosinski M (2001) Interpreting SF-36 summary health measures: a response. Qual Life Res Int J Qual Life Asp Treat Care Rehabil 10:405–413 discussion 415–420 CrossRef Ware JE, Kosinski M (2001) Interpreting SF-36 summary health measures: a response. Qual Life Res Int J Qual Life Asp Treat Care Rehabil 10:405–413 discussion 415–420 CrossRef
12.
go back to reference Weiner S, Neugehauer EA (2013) Quality of life of diabetic patients with medical or surgical treatment. Nutr Hosp 28(Suppl 2):66–77PubMed Weiner S, Neugehauer EA (2013) Quality of life of diabetic patients with medical or surgical treatment. Nutr Hosp 28(Suppl 2):66–77PubMed
13.
go back to reference Oldridge NB, Stump TE, Nothwehr FK, Clark DO (2001) Prevalence and outcomes of comorbid metabolic and cardiovascular conditions in middle- and older-age adults. J Clin Epidemiol 54:928–934CrossRefPubMed Oldridge NB, Stump TE, Nothwehr FK, Clark DO (2001) Prevalence and outcomes of comorbid metabolic and cardiovascular conditions in middle- and older-age adults. J Clin Epidemiol 54:928–934CrossRefPubMed
14.
go back to reference Torquati A, Lutfi RE, Richards WO (2007) Predictors of early quality-of-life improvement after laparoscopic gastric bypass surgery. Am J Surg 193:471–475CrossRefPubMed Torquati A, Lutfi RE, Richards WO (2007) Predictors of early quality-of-life improvement after laparoscopic gastric bypass surgery. Am J Surg 193:471–475CrossRefPubMed
15.
go back to reference Dixon JB, Dixon ME, O’Brien PE (2001) Quality of life after lap-band placement: influence of time, weight loss, and comorbidities. Obes Res 9:713–721CrossRefPubMed Dixon JB, Dixon ME, O’Brien PE (2001) Quality of life after lap-band placement: influence of time, weight loss, and comorbidities. Obes Res 9:713–721CrossRefPubMed
16.
go back to reference Karlsson J, Sjostrom L, Sullivan M (1998) Swedish obese subjects (SOS)—an intervention study of obesity. Two-year follow-up of health-related quality of life (HRQL) and eating behavior after gastric surgery for severe obesity. Int J Obes Relat Metab disord J Int Assoc Study Obes 22:113–126CrossRef Karlsson J, Sjostrom L, Sullivan M (1998) Swedish obese subjects (SOS)—an intervention study of obesity. Two-year follow-up of health-related quality of life (HRQL) and eating behavior after gastric surgery for severe obesity. Int J Obes Relat Metab disord J Int Assoc Study Obes 22:113–126CrossRef
17.
go back to reference Julia C, Ciangura C, Capuron L, Bouillot JL, Basdevant A, Poitou C, Oppert JM (2013) Quality of life after Roux-en-Y gastric bypass and changes in body mass index and obesity-related comorbidities. Diabetes metab 39:148–154CrossRefPubMed Julia C, Ciangura C, Capuron L, Bouillot JL, Basdevant A, Poitou C, Oppert JM (2013) Quality of life after Roux-en-Y gastric bypass and changes in body mass index and obesity-related comorbidities. Diabetes metab 39:148–154CrossRefPubMed
18.
go back to reference Vincent HK, Ben-David K, Conrad BP, Lamb KM, Seay AN, Vincent KR (2012) Rapid changes in gait, musculoskeletal pain, and quality of life after bariatric surgery. Surg Obes Relat Dis Off J Am Soc Bariatr Surg 8:346–354CrossRef Vincent HK, Ben-David K, Conrad BP, Lamb KM, Seay AN, Vincent KR (2012) Rapid changes in gait, musculoskeletal pain, and quality of life after bariatric surgery. Surg Obes Relat Dis Off J Am Soc Bariatr Surg 8:346–354CrossRef
19.
go back to reference American Diabetes Association (2013) Standards of medical care in diabetes–2013. Diabetes care 36(Suppl 1):S11–S66CrossRef American Diabetes Association (2013) Standards of medical care in diabetes–2013. Diabetes care 36(Suppl 1):S11–S66CrossRef
20.
go back to reference Khoo CM, Chen J, Pamuklar Z, Torquati A (2014) Effects of Roux-en-Y Gastric Bypass or Diabetes Support and Education on Insulin Sensitivity and Insulin Secretion in Morbidly Obese Patients With Type 2 Diabetes. Ann Surg 259(3):494–501CrossRefPubMedPubMedCentral Khoo CM, Chen J, Pamuklar Z, Torquati A (2014) Effects of Roux-en-Y Gastric Bypass or Diabetes Support and Education on Insulin Sensitivity and Insulin Secretion in Morbidly Obese Patients With Type 2 Diabetes. Ann Surg 259(3):494–501CrossRefPubMedPubMedCentral
21.
go back to reference Bergman RN, Finegood DT, Ader M (1985) Assessment of insulin sensitivity in vivo. Endocr Rev 6:45–86CrossRefPubMed Bergman RN, Finegood DT, Ader M (1985) Assessment of insulin sensitivity in vivo. Endocr Rev 6:45–86CrossRefPubMed
22.
go back to reference Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419CrossRefPubMed Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419CrossRefPubMed
23.
go back to reference Sarwer DB, Wadden TA, Moore RH, Eisenberg MH, Raper SE, Williams NN (2010) Changes in quality of life and body image after gastric bypass surgery. Surg Obes Relat Dis Off J Am Soc Bariatr Surg 6:608–614CrossRef Sarwer DB, Wadden TA, Moore RH, Eisenberg MH, Raper SE, Williams NN (2010) Changes in quality of life and body image after gastric bypass surgery. Surg Obes Relat Dis Off J Am Soc Bariatr Surg 6:608–614CrossRef
24.
go back to reference Hill-Briggs F, Gary TL, Baptiste-Roberts K, Brancati FL (2005) Thirty-six-item short-form outcomes following a randomized controlled trial in type 2 diabetes. Diabetes Care 28:443–444CrossRefPubMed Hill-Briggs F, Gary TL, Baptiste-Roberts K, Brancati FL (2005) Thirty-six-item short-form outcomes following a randomized controlled trial in type 2 diabetes. Diabetes Care 28:443–444CrossRefPubMed
25.
go back to reference Lobo CM, Frijling BD, Hulscher ME, Bernsen RM, Grol RP, Prins A, van der Wouden JC (2004) Effect of a comprehensive intervention program targeting general practice staff on quality of life in patients at high cardiovascular risk: a randomized controlled trial. Qual Life Res Int J Qual Life Asp Treat Care Rehabil 13:73–80CrossRef Lobo CM, Frijling BD, Hulscher ME, Bernsen RM, Grol RP, Prins A, van der Wouden JC (2004) Effect of a comprehensive intervention program targeting general practice staff on quality of life in patients at high cardiovascular risk: a randomized controlled trial. Qual Life Res Int J Qual Life Asp Treat Care Rehabil 13:73–80CrossRef
26.
go back to reference Klein S, Sheard NF, Pi-Sunyer X, Daly A, Wylie-Rosett J, Kulkarni K, Clark NG (2004) Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies: a statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition. Diabetes Care 27:2067–2073CrossRefPubMed Klein S, Sheard NF, Pi-Sunyer X, Daly A, Wylie-Rosett J, Kulkarni K, Clark NG (2004) Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies: a statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition. Diabetes Care 27:2067–2073CrossRefPubMed
27.
go back to reference Bjorner JB, Lyng Wolden M, Gundgaard J, Miller KA (2013) Benchmarks for interpretation of score differences on the SF-36 health survey for patients with diabetes. Value Health J Int Soc Pharmacoecon Outcomes Res 16:993–1000CrossRef Bjorner JB, Lyng Wolden M, Gundgaard J, Miller KA (2013) Benchmarks for interpretation of score differences on the SF-36 health survey for patients with diabetes. Value Health J Int Soc Pharmacoecon Outcomes Res 16:993–1000CrossRef
28.
go back to reference Jacobson AM, de Groot M, Samson JA (1994) The evaluation of two measures of quality of life in patients with type I and type II diabetes. Diabetes Care 17:267–274CrossRefPubMed Jacobson AM, de Groot M, Samson JA (1994) The evaluation of two measures of quality of life in patients with type I and type II diabetes. Diabetes Care 17:267–274CrossRefPubMed
29.
go back to reference Chang CY, Huang CK, Chang YY, Tai CM, Lin JT, Wang JD (2010) Prospective study of health-related quality of life after Roux-en-Y bypass surgery for morbid obesity. Br J Surg 97:1541–1546CrossRefPubMed Chang CY, Huang CK, Chang YY, Tai CM, Lin JT, Wang JD (2010) Prospective study of health-related quality of life after Roux-en-Y bypass surgery for morbid obesity. Br J Surg 97:1541–1546CrossRefPubMed
30.
go back to reference Kolotkin RL, Norquist JM, Crosby RD, Suryawanshi S, Teixeira PJ, Heymsfield SB, Erondu N, Nguyen AM (2009) One-year health-related quality of life outcomes in weight loss trial participants: comparison of three measures. Health Qual Life Outcomes 7:53CrossRefPubMedPubMedCentral Kolotkin RL, Norquist JM, Crosby RD, Suryawanshi S, Teixeira PJ, Heymsfield SB, Erondu N, Nguyen AM (2009) One-year health-related quality of life outcomes in weight loss trial participants: comparison of three measures. Health Qual Life Outcomes 7:53CrossRefPubMedPubMedCentral
31.
go back to reference Donald M, Dower J, Coll JR, Baker P, Mukandi B, Doi SA (2013) Mental health issues decrease diabetes-specific quality of life independent of glycaemic control and complications: findings from Australia’s living with diabetes cohort study. Health Qual Life Outcomes 11:170CrossRefPubMedPubMedCentral Donald M, Dower J, Coll JR, Baker P, Mukandi B, Doi SA (2013) Mental health issues decrease diabetes-specific quality of life independent of glycaemic control and complications: findings from Australia’s living with diabetes cohort study. Health Qual Life Outcomes 11:170CrossRefPubMedPubMedCentral
32.
go back to reference Klein BE, Klein R, Moss SE (1998) Self-rated health and diabetes of long duration. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. Diabetes Care 21:236–240CrossRefPubMed Klein BE, Klein R, Moss SE (1998) Self-rated health and diabetes of long duration. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. Diabetes Care 21:236–240CrossRefPubMed
33.
go back to reference Rubin RR, Peyrot M (1999) Quality of life and diabetes. Diabetes/Metab Res Rev 15:205–218CrossRef Rubin RR, Peyrot M (1999) Quality of life and diabetes. Diabetes/Metab Res Rev 15:205–218CrossRef
34.
go back to reference Petterson T, Lee P, Hollis S, Young B, Newton P, Dornan T (1998) Well-being and treatment satisfaction in older people with diabetes. Diabetes Care 21:930–935CrossRefPubMed Petterson T, Lee P, Hollis S, Young B, Newton P, Dornan T (1998) Well-being and treatment satisfaction in older people with diabetes. Diabetes Care 21:930–935CrossRefPubMed
35.
go back to reference Glasgow RE, Ruggiero L, Eakin EG, Dryfoos J, Chobanian L (1997) Quality of life and associated characteristics in a large national sample of adults with diabetes. Diabetes Care 20:562–567CrossRefPubMed Glasgow RE, Ruggiero L, Eakin EG, Dryfoos J, Chobanian L (1997) Quality of life and associated characteristics in a large national sample of adults with diabetes. Diabetes Care 20:562–567CrossRefPubMed
Metadata
Title
Gastric bypass significantly improves quality of life in morbidly obese patients with type 2 diabetes
Authors
Philip Omotosho
Alessandro Mor
Prapimporn Chattranukulchai Shantavasinkul
Leonor Corsino
Alfonso Torquati
Publication date
01-07-2016
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 7/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-015-4568-0

Other articles of this Issue 7/2016

Surgical Endoscopy 7/2016 Go to the issue