Effectiveness and safety of laparoscopic Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus

Zhang,Pin; Zhang,Hongwei; Han,Xiaodong; Di,Jianzhong; Zhou,Yulong; Li,Kun; Zheng,Qi

doi:10.3892/etm.2016.2973

Effectiveness and safety of laparoscopic Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus

Authors:
- Pin Zhang
- Hongwei Zhang
- Xiaodong Han
- Jianzhong Di
- Yulong Zhou
- Kun Li
- Qi Zheng
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Affiliations: Department of General Surgery, The Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, P.R. China
Published online on: January 11, 2016 https://doi.org/10.3892/etm.2016.2973
Pages: 827-831
Copyright: © Zhang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Gastric bypass may be conducted to aid in glycemic control in adults with type 2 diabetes mellitus (T2DM). The aim of the present study was to investigate the clinical results of diabetes remission and metabolic syndrome in individuals with T2DM after undergoing a gastric bypass. A total of 85 patients (39 men and 46 women) with T2DM underwent laparoscopic Roux‑en‑Y gastric bypass (LRYGB). Data regarding patient demographics, body mass index (BMI), co‑morbidities and details of diabetes mellitus, including disease duration, remission, β‑cell function, blood lipid levels and nutritive status were prospectively collected and analyzed. The mean duration from the onset of T2DM was 7.79±4.84 years (range, 1 month to 22 years). The preoperative mean BMI was 31.60±4.10 (range, 28.53‑48.10 kg/m2), mean percentage of body fat was 36.35±9.12% (range, 18‑56%), and the mean HbA1c was 8.32±2.13% (range, 7‑15.9%). Five patients (5.9%) developed complications without mortality. T2DM and β‑cell function were significantly improved from by month 6 after surgery (P<0.05). Improvements in central obesity, blood pressure (BP; systolic and diastolic) control, blood lipid levels were observed, without malnutrition or severe anemia. Therefore, the present results indicate that laparoscopic RYGBP is a safe and effective procedure for improving glycemic control, obesity, body fat percentage and BP in patients with T2DM and obesity.

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1	Wild S, Roglic G, Green A, Sicree R and King H: Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care. 27:1047–1053. 2004. View Article : Google Scholar : PubMed/NCBI
2	Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, Shan Z, Liu J, Tian H, Ji Q, et al: Prevalence of diabetes among men and women in China. N Engl J Med. 362:1090–1101. 2010. View Article : Google Scholar : PubMed/NCBI
3	Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K and Schoelles K: Bariatric surgery: A systematic review and meta-analysis. JAMA. 292:1724–1737. 2004. View Article : Google Scholar : PubMed/NCBI
4	Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP and Sledge I: Weight and type 2 diabetes after bariatric surgery: Systematic review and meta-analysis. Am J Med. 122:248–256. 2009. View Article : Google Scholar : PubMed/NCBI
5	Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, Thomas S, Abood B, Nissen SE and Bhatt DL: Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 366:1567–1576. 2012. View Article : Google Scholar : PubMed/NCBI
6	Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Leccesi L, Nanni G, Pomp A, Castagneto M, Ghirlanda G and Rubino F: Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 366:1577–1585. 2012. View Article : Google Scholar : PubMed/NCBI
7	Dixon JB, Zimmet P, Alberti KG and Rubino F: International Diabetes Federation Taskforce on Epidemiology and Prevention: Bariatric surgery: An IDF statement for obese Type 2 diabetes. Diabet Med. 28:628–642. 2011. View Article : Google Scholar : PubMed/NCBI
8	American Diabetes Association: Standards of medical care in diabetes - 2006. Diabetes Care. 29(Suppl 1): S4–S42. 2006.PubMed/NCBI
9	Huang CK, Lee YC, Hung CM, Chen YS and Tai CM: Laparoscopic Roux-en-Y gastric bypass for morbidly obese Chinese patients: Learning curve, advocacy and complications. Obes Surg. 18:776–781. 2008. View Article : Google Scholar : PubMed/NCBI
10	American Diabetes Association: Diagnosis and classification of diabetes mellitus. Diabetes Care. 33(Suppl 1): S62–S69. 2010.PubMed/NCBI
11	Rubino F, Schauer PR, Kaplan LM and Cummings DE: Metabolic surgery to treat type 2 diabetes: Clinical outcomes and mechanism of action. Annu Rev Med. 61:393–411. 2010. View Article : Google Scholar : PubMed/NCBI
12	Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Brethauer SA, Navaneethan SD, Aminian A, Pothier CE, Kim ES, Nissen SE and Kashyap SR: STAMPEDE Investigators: Bariatric surgery versus intensive medical therapy for diabetes - 3-year outcomes. N Engl J Med. 370:2002–2013. 2014. View Article : Google Scholar : PubMed/NCBI
13	Rubino F, Forgione A, Cummings DE, Vix M, Gnuli D, Mingrone G, Castagneto M and Marescaux J: 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. 244:741–749. 2006. View Article : Google Scholar : PubMed/NCBI
14	Cohen RV, Schiavon CA, Pinheiro JS, Correa JL and Rubino F: Duodenal-jejunal bypass for the treatment of type 2 diabetes in patients with body mass index of 22–34 kg/m²: A report of 2 cases. Surg Obes Relat Dis. 3:195–197. 2007. View Article : Google Scholar : PubMed/NCBI
15	DePaula AL, Macedo AL, Mota BR and Schraibman V: 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. 23:1313–1320. 2009. View Article : Google Scholar : PubMed/NCBI
16	DePaula AL, Macedo AL, Schraibman V, Mota BR and Vencio S: Hormonal evaluation following laparoscopic treatment of type 2 diabetes mellitus patients with BMI 20–34. Surg Endosc. 23:1724–1732. 2009. View Article : Google Scholar : PubMed/NCBI
17	Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, Lystig T, Sullivan M, Bouchard C, Carlsson B, et al: Effects of bariatric surgery on mortality in Swedish obese subjects. N Eng J Med. 357:741–752. 2007. View Article : Google Scholar
18	Sjöström L, Gummesson A, Sjöström CD, Narbro K, Peltonen M, Wedel H, Bengtsson C, Bouchard C, Carlsson B, Dahlgren S, et al: Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): A prospective controlled intervention trial. Lancet Oncol. 10:653–662. 2009. View Article : Google Scholar : PubMed/NCBI
19	Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, Lamonte MJ, Stroup AM and Hunt SC: Long-term mortality after gastric bypass surgery. N Engl J Med. 357:753–761. 2007. View Article : Google Scholar : PubMed/NCBI
20	Christou NV, Sampalis JS, Liberman N, Look D, Auger S, McLean AP and MacLean LD: Surgery decreases long-term mortality, morbidity and health care use in morbidly obese patients. Ann Surg. 240:416–423. 2004. View Article : Google Scholar : PubMed/NCBI
21	Csendes A, Burdiles P, Papapietro K and Burgos AM: Review of the results of medical and surgical treatment of morbid obesity. Rev Med Chil. 137:559–566. 2009.(In Spanish). PubMed/NCBI
22	Nguyen NT, Hinojosa M, Fayad C, Varela E and Wilson SE: Use and outcomes of laparoscopic versus open gastric bypass at academic medical centers. J Am Coll Surg. 205:248–55. 2007. View Article : Google Scholar : PubMed/NCBI
23	Allen RE, Hughes TD, Ng JL, Ortiz RD, Ghantous MA, Bouhali O, Froguel P and Arredouani A: Mechanisms behind the immediate effects of Roux-en-Y gastric bypass surgery on type 2 diabetes. Theor Biol Med Model. 10:452013. View Article : Google Scholar : PubMed/NCBI
24	Samat A, Malin SK, Huang H, Schauer PR, Kirwan JP and Kashyap SR: Ghrelin suppression is associated with weight loss and insulin action following gastric bypass surgery at 12 months in obese adults with type 2 diabetes. Diabetes Obes Metab. 15:963–966. 2013. View Article : Google Scholar : PubMed/NCBI
25	Lanzarini E, Csendes A, Lembach H, Molina J, Gutiérrez L and Silva J: Evolution of type 2 diabetes mellitus in non morbid obese gastrectomized patients with Roux en Y reconstruction: Retrospective study. World J Surg. 34:2098–2102. 2010. View Article : Google Scholar : PubMed/NCBI
26	Karefylakis C, Näslund I, Edholm D, Sundbom M, Karlsson FA and Rask E: Vitamin D status 10 years after primary gastric bypass: Gravely high prevalence of hypovitaminosis D and raised PTH levels. Obes Surg. 24:343–348. 2014. View Article : Google Scholar : PubMed/NCBI
27	Vidal P, Ramón JM, Goday A, Parri A, Crous X, Trillo L, Pera M and Grande L: Lack of adherence to follow-up visits after bariatric surgery: Reasons and outcome. Obes Surg. 24:179–183. 2014. View Article : Google Scholar : PubMed/NCBI