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Published in: Obesity Surgery 9/2011

Open Access 01-09-2011 | Clinical Research

Laparoscopic Roux-en-Y Gastric Bypass for the Treatment of Type II Diabetes Mellitus in Chinese Patients with Body Mass Index of 25–35

Authors: Chih-Kun Huang, Asim Shabbir, Chi-Hsien Lo, Chi-Ming Tai, Yaw-Sen Chen, Jer-Yiing Houng

Published in: Obesity Surgery | Issue 9/2011

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Abstract

Background

Laparoscopic Roux-en-Y gastric bypass (LRYGB) can dramatically ameliorate type 2 diabetes mellitus (T2DM) in morbidly obese patients. However, there is little evidence supporting the effectiveness of LRYGB in low body mass index (BMI) patients. The study was designed to evaluate the safety and results of LRYGB for achieving T2DM remission in patients with BMI in the range of 25–35 kg/m2.

Methods

Twenty-two patients (two men and 20 women) with T2DM underwent LRYGB. Data on patient demographics, BMI, co-morbidities, and details of diabetes mellitus, including disease duration, family history, medication use, and remission, were prospectively collected and analyzed.

Results

The mean age was 47 years (range, 28–63 years), mean BMI was 30.81 (range, 25.00–34.80 kg/m2), and mean duration of T2DM onset was 6.57 years (range, 1–20 years). Sixteen (72.27%) patients had a family history of T2DM. There was no mortality, but two (9%) patients experienced complications: an early gastrojejunostomy hemorrhage and frequent loose stools that required revision surgery. At 12 months, 14 (63.6%) patients showed T2DM remission, six (27.3%) showed glycemic control, and two (9.1%) showed improvement. The group achieving remission had a higher BMI (p = 0.001), younger age (p = 0.002), and shorter duration of diabetes (p = 0.001). These three factors may be predictors of diabetes resolution at 12 months.

Conclusion

Early intervention in low-BMI patients yields better remission rates because age, BMI, and duration of T2DM predict glycemic outcomes.
Literature
1.
go back to reference Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047–53.PubMedCrossRef Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047–53.PubMedCrossRef
2.
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
3.
4.
go back to reference Brancatisano A, Wahlroos S, Brancatisano R. Improvement in comorbid illness after placement of the Swedish adjustable gastric band. Surg Obes Relat Dis. 2008;4:S39–46.PubMedCrossRef Brancatisano A, Wahlroos S, Brancatisano R. Improvement in comorbid illness after placement of the Swedish adjustable gastric band. Surg Obes Relat Dis. 2008;4:S39–46.PubMedCrossRef
5.
go back to reference Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–56.PubMedCrossRef Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–56.PubMedCrossRef
6.
go back to reference Hussain A, Mahmood H, El-Hasani S. Can Roux-en-Y gastric bypass provide a lifelong solution for diabetes mellitus? Can J Surg. 2009;52:269–75. Hussain A, Mahmood H, El-Hasani S. Can Roux-en-Y gastric bypass provide a lifelong solution for diabetes mellitus? Can J Surg. 2009;52:269–75.
7.
go back to reference Expert Committee on the diagnosis and classification of diabetes mellitus. Report of the Expert Committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26:S5–20.CrossRef Expert Committee on the diagnosis and classification of diabetes mellitus. Report of the Expert Committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26:S5–20.CrossRef
8.
go back to reference Huang CK, Lee YC, Hung CM, et al. Laparoscopic Roux-en-Y gastric bypass for morbidly obese Chinese patients: learning curve, advocacy and complications. Obes Surg. 2008;18:776–81. Epub 2008 May 16.PubMedCrossRef Huang CK, Lee YC, Hung CM, et al. Laparoscopic Roux-en-Y gastric bypass for morbidly obese Chinese patients: learning curve, advocacy and complications. Obes Surg. 2008;18:776–81. Epub 2008 May 16.PubMedCrossRef
9.
go back to reference American Diabetes Association. Standards of medical care in diabetes: 2006, position statement. Diabetes Care. 2006;29:4–42. American Diabetes Association. Standards of medical care in diabetes: 2006, position statement. Diabetes Care. 2006;29:4–42.
10.
11.
go back to reference American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33:62–9.CrossRef American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33:62–9.CrossRef
12.
go back to reference Rubino F, Schauer PR, Kaplan LM, et al. Metabolic surgery to treat type 2 diabetes: clinical outcomes and mechanism of action. Annu Rev Med. 2010;61:393–411.PubMedCrossRef Rubino F, Schauer PR, Kaplan LM, et al. Metabolic surgery to treat type 2 diabetes: clinical outcomes and mechanism of action. Annu Rev Med. 2010;61:393–411.PubMedCrossRef
13.
go back to reference Gastrointestinal Surgery for Severe Obesity. NIH Consens Dev Conf Consens Statement 1991; Mar 25–27; 9(1). Gastrointestinal Surgery for Severe Obesity. NIH Consens Dev Conf Consens Statement 1991; Mar 25–27; 9(1).
14.
go back to reference Friedman MN, Sancetta AJ, Magovern GJ. The amelioration of diabetes mellitus following subtotal gastrectomy. Surg Gynecol Obstet. 1955;100:201–4.PubMed Friedman MN, Sancetta AJ, Magovern GJ. The amelioration of diabetes mellitus following subtotal gastrectomy. Surg Gynecol Obstet. 1955;100:201–4.PubMed
15.
go back to reference Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–52.PubMedCrossRef Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–52.PubMedCrossRef
16.
go back to reference Rubino F, Kaplan LM, Schauer PR. Diabetes Surgery Summit delegates. 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.PubMedCrossRef Rubino F, Kaplan LM, Schauer PR. Diabetes Surgery Summit delegates. 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.PubMedCrossRef
17.
go back to reference Shah SS, Todkar JS, Shah PS et al. Diabetes remission and reduced cardiovascular risk after gastric bypass in Asian Indians with body mass index < 35 kg/m2. Surg Obes Relat Dis 2009;6:332–8. Shah SS, Todkar JS, Shah PS et al. Diabetes remission and reduced cardiovascular risk after gastric bypass in Asian Indians with body mass index < 35 kg/m2. Surg Obes Relat Dis 2009;6:332–8.
18.
go back to reference Parikh M, Duncombe J, Fielding GA. Laparoscopic adjustable gastric banding for patients with body mass index of 35 kg/m2. Surg Obes Relat Dis. 2006;2:518–22.PubMedCrossRef Parikh M, Duncombe J, Fielding GA. Laparoscopic adjustable gastric banding for patients with body mass index of 35 kg/m2. Surg Obes Relat Dis. 2006;2:518–22.PubMedCrossRef
19.
go back to reference Scopinaro N, Papadia F, Marinari G, et al. Long-term control of type 2 diabetes mellitus and the other major components of the metabolic syndrome after biliopancreatic diversion in patients with BMI < 35 kg/m2. Obes Surg. 2007;17:185–92.PubMedCrossRef Scopinaro N, Papadia F, Marinari G, et al. Long-term control of type 2 diabetes mellitus and the other major components of the metabolic syndrome after biliopancreatic diversion in patients with BMI < 35 kg/m2. Obes Surg. 2007;17:185–92.PubMedCrossRef
20.
go back to reference Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg. 2006;244:741–9.PubMedCrossRef Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg. 2006;244:741–9.PubMedCrossRef
21.
go back to reference Cohen RV, Schiavon CA, Pinheiro JS, et al. Duodenal-jejunal bypass for the treatment of type 2 diabetes in patients with BMI 22–34: a report of two cases. Surg Obes Relat Dis. 2007;3:195–7.PubMedCrossRef Cohen RV, Schiavon CA, Pinheiro JS, et al. Duodenal-jejunal bypass for the treatment of type 2 diabetes in patients with BMI 22–34: a report of two cases. Surg Obes Relat Dis. 2007;3:195–7.PubMedCrossRef
22.
go back to reference DePaula AL, Macedo AL, Mota BR, et al. Laparoscopic ileal interposition associated to a diverted sleeve gastrectomy is an effective operation for the treatment of type 2 diabetes mellitus patients with BMI 21–29. Surg Endosc. 2009;23:1313–20.PubMedCrossRef DePaula AL, Macedo AL, Mota BR, et al. Laparoscopic ileal interposition associated to a diverted sleeve gastrectomy is an effective operation for the treatment of type 2 diabetes mellitus patients with BMI 21–29. Surg Endosc. 2009;23:1313–20.PubMedCrossRef
23.
go back to reference DePaula AL, Macedo AL, Schraibman V, et al. Hormonal evaluation following laparoscopic treatment of type 2 diabetes mellitus patients with BMI 20–34. Surg Endosc. 2009;23:1724–32.PubMedCrossRef DePaula AL, Macedo AL, Schraibman V, et al. Hormonal evaluation following laparoscopic treatment of type 2 diabetes mellitus patients with BMI 20–34. Surg Endosc. 2009;23:1724–32.PubMedCrossRef
24.
go back to reference Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238:467–84.PubMed Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238:467–84.PubMed
25.
go back to reference Cohen R, Pinheiro JS, Correa JL, et al. Laparoscopic Roux-en-Y gastric bypass for BMI < 35 kg/m2: a tailored approach. Surg Obes Relat Dis. 2006;2:401–4.PubMedCrossRef Cohen R, Pinheiro JS, Correa JL, et al. Laparoscopic Roux-en-Y gastric bypass for BMI < 35 kg/m2: a tailored approach. Surg Obes Relat Dis. 2006;2:401–4.PubMedCrossRef
26.
go back to reference Lee WJ, Wang W, Lee YC, et al. Effect of laparoscopic minigastric bypass for type 2 diabetes mellitus: comparison of BMI >35 and <35 kg/m2. J Gastrointest Surg. 2008;12:945–52.PubMedCrossRef Lee WJ, Wang W, Lee YC, et al. Effect of laparoscopic minigastric bypass for type 2 diabetes mellitus: comparison of BMI >35 and <35 kg/m2. J Gastrointest Surg. 2008;12:945–52.PubMedCrossRef
27.
go back to reference Fried M, Ribaric G, Buchwald JN, et al. Metabolic surgery for the treatment of type 2 diabetes in patients with BMI < 35 kg/m2: an integrative review of early studies. Obes Surg. 2010;20:776–90.PubMedCrossRef Fried M, Ribaric G, Buchwald JN, et al. Metabolic surgery for the treatment of type 2 diabetes in patients with BMI < 35 kg/m2: an integrative review of early studies. Obes Surg. 2010;20:776–90.PubMedCrossRef
28.
go back to reference Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg. 2004;239:1–11.PubMedCrossRef Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg. 2004;239:1–11.PubMedCrossRef
29.
go back to reference Keating CL, Dixon JB, Moodie ML, et al. Cost-efficacy of surgically induced weight loss for the management of type 2 diabetes. A randomised controlled trial. Diabetes Care. 2009;32:580–4.PubMedCrossRef Keating CL, Dixon JB, Moodie ML, et al. Cost-efficacy of surgically induced weight loss for the management of type 2 diabetes. A randomised controlled trial. Diabetes Care. 2009;32:580–4.PubMedCrossRef
30.
go back to reference Hall TC, Pellen MG, Sedman PC, et al. Preoperative factors predicting remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass surgery for obesity. Obes Surg. 2010;20:1245–50.PubMedCrossRef Hall TC, Pellen MG, Sedman PC, et al. Preoperative factors predicting remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass surgery for obesity. Obes Surg. 2010;20:1245–50.PubMedCrossRef
Metadata
Title
Laparoscopic Roux-en-Y Gastric Bypass for the Treatment of Type II Diabetes Mellitus in Chinese Patients with Body Mass Index of 25–35
Authors
Chih-Kun Huang
Asim Shabbir
Chi-Hsien Lo
Chi-Ming Tai
Yaw-Sen Chen
Jer-Yiing Houng
Publication date
01-09-2011
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 9/2011
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-011-0408-z

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