Effect of Laparoscopic Roux‐en‐Y Gastric Bypass on Type 2 Diabetes Mellitus

Abstract

Objective: To evaluate pre-and postoperative clinical parameters associated with improvement of diabetes up to 4 years after laparoscopic Roux-en-Y gastric bypass (LRYGBP) in patients with type 2 diabetes mellitus (T2DM). Summary Background Data: The surgical treatment of morbid obesity leads to dramatic improvement in the comorbidity status of most patients with T2DM. However, little is known concerning what preoperative clinical factors are associated with postoperative longterm improvement in diabetes in the morbidly obese patient with diabetes. Methods: We evaluated pre-and postoperative data, including demographics, duration of diabetes, metabolic parameters, and clinical outcomes, in all patients with impaired fasting glucose (IFG) and type T2DM undergoing LRYGBP from July 1997 to May 2002. Results: During this 5-year period, 1160 patients underwent LRYGBP and 240 (21%) had IFG or T2DM. Follow up was possible in 191 of 240 patients (80%). There were 144 females (75%) with a mean preoperative age of 48 years (range, 26-67 years). After surgery, weight and body mass index decreased from 308 lbs and 50.1 kg/m 2 to 211 lbs and 34 kg/m 2 for a mean weight loss of 97 lbs and mean excess weight loss of 60%. Fasting plasma glucose and glycosylated hemoglobin concentrations returned to normal levels (83%) or markedly improved (17%) in all patients. A significant reduction in use of oral antidiabetic agents (80%) and insulin (79%) followed surgical treatment. Patients with the shortest duration (Ͻ5 years), the mildest form of T2DM (diet controlled), and the greatest weight loss after surgery were most likely to achieve complete resolution of T2DM. Conclusion: LRYGBP resulted in significant weight loss (60% percent of excess body weight loss) and resolution (83%) of T2DM. Patients with the shortest duration and mildest form of T2DM had a higher rate of T2DM resolution after surgery, suggesting that early surgical intervention is warranted to increase the likelihood of rendering patients euglycemic.

The big fat bariatric bandwagon

“…A relevant comparison might be with gestational diabetes, in which the escalating insulin demands of pregnancy exceed the capacity of the pancreatic islets to respond, yet normoglycaemia is restored following delivery-a 'remission' that, as we know, is often transient. This is consistent with the observation that hyperglycaemia is most effectively controlled by surgery in those with disease of a shorter duration, whereas those with a longer duration of diabetes or higher treatment requirements derive less benefit [32,39]. In agreement with this, a recent retrospective report highlights the extent to which long-term glycaemic control may eventually deteriorate after gastric bypass [40].…”

Evidence-based medicine reports on obesity surgery: a critique

“…17 Other studies published since these EBM reports have shown better control of T2DM and hypertension with greater weight loss. 51,52 Evaluation of newer techniques in bariatric surgery The risks and benefits of laparoscopic gastric bypass, that is, the early benefits of the laparoscopic vs the open approach, are omitted in the TEC study. This report fails to mention the shorter length of hospital stay, the significant decrease in pain, and wound complications the early improvement in quality of life and earlier return to work with the laparoscopic approach.…”

Bariatrische Chirurgie bei extremer Adipositas im Kindes- und Jugendalter

“…Durch eine Magenbypass-Operation verändert sich zudem die physiologische Antwort auf die an der Blutglukose-und Appetitregulation beteiligten Hormone Ghrelin, Glukagon-like-peptide-1 (GLP-1) und PYY-36 [24,25]. Daher hat sich kürzlich der Begriff der "metabolischen Chirurgie" etabliert [26,27,28].…”