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

Abstract

BackgroundLaparoscopic 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.MethodsTwenty-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.ResultsThe 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.ConclusionEarly intervention in low-BMI patients yields better remission rates because age, BMI, and duration of T2DM predict glycemic outcomes.

Gastric Bypass Increases Postprandial Insulin and GLP-1 in Nonobese Minipigs

“…Interestingly, the results point to a causal role of the proximal segments of the gastric bypass for the increase in GLP-1 secretion, minimizing the contribution of malabsorption and weight loss. This model could be very helpful in shedding light on the mechanisms responsible for the side effects of RYGB in diabetes remission and in justifying the development of metabolic surgery as a form of treatment of nonobese diabetic patients [15,24,25]. …”

Obesity Management-Bariatric Surgery vs Lifestyle Modification

“…Higher rates of remission is seen in diabetic patients with shorter duration. Complete remission was observed with BMI above 32 [3]. This surgery carries a mortality rate of 0.4.…”

Bariatric and Metabolic Surgery

“…Type 2 Diabetes Mellitus resolution is as high as 90.9% with mean fasting glucose reduction from 204 to 103 mg/dl, mean HbA1c reduction from 9.2 to 5.9% without T2DM medication in 12 months follow up. Up to 90% of patient did not need medication for control of glycaemia post operatively [19]. Gastric bypass can achieve a dramatic improvement of nonalcoholic fatty liver disease (NAFLD) both biochemically and histologically in morbid obesity [20].…”