Efficacy and safety analysis of laparoscopic Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus with low body mass index

doi:10.3877/cma.j.issn.2095-9605.2017.04.006

Abstract

Abstract:

Objective

To investigate the efficacy and safety of laparoscopic Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus (T2DM) with low body mass index (BMI).

Methods

clinical data of 81 patients with T2DM undergoing laparoscopic Roux-en-Y gastric bypass in the Daping hospital of Army Medical University between May 2010 and May 2017 were studied retrospectively. According to their BMI, these patients were divided into the higher BMI group (BMI>27.5 kg/m²) and lower BMI group (BMI≤27.5 kg/m²). 53 patients were included into the BMI>27.5 kg/m² group, among them, 31 were males and 22 were females with an average age of (41.4±11.3) years old. 28 patients were included into the BMI≤27.5 kg/m² group, among them, 13 were males and 15 were females with an average age of (48.5±7.5) years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. BMI, Waist, Fasting plasma glucose (FPG), glycosylated hemoglobin A1c (HbA1c), total cholesterol, triglyceride, high density lipoprotein cholesterol and low density lipoprotein cholesterol after 1, 3, 6, 12, 24, 36 months were compared.

Results

The FPG, HbA1c, BMI and waist declined over time after surgery in both groups, and maintained stable 6 months after surgery, which were significantly lower than the preoperative (P<0.05). At 24 months after surgery, the average FPG level of the BMI≤27.5 kg/m² group was significantly lower than that before surgery (t=2.226, P<0.05), but had no statistical difference with that of the BMI>27.5 kg/m² group (t= -1.21, P>0.05); the average HbA1c level of the BMI≤27.5 kg/m² group was significantly lower than that before surgery (t=2.513, P<0.05), but had no statistical difference with that of the BMI>27.5 kg/m² group (t= -0.181, P>0.05). Although the average TC, TG, LDL-C level of two groups showed a decreasing trend, they had no statistical difference with the preoperative (P>0.05). The average HDL-C level of two groups showed an increasing trend, but had no statistical difference with the preoperative (P>0.05). There were no significant difference in glucose and lipid metabolism at any point in both groups. The differences of clinical complete remission rate and partial remission rate of T2DM among two groups were not statistically significant (P>0.05). There were no early and late mortality, and seven patients (8.6%) developed early or late complications.

Conclusions

Laparoscopic Roux-en-Y gastric bypass can significantly reduce weight and improve glucose and lipid metabolism for T2DM with low BMI, and the short-term and long-term postoperative safety is reliable.

Key words: Laparoscopic Roux-en-Y gastric bypass, Diabetes mellitus, Type 2, Body mass index

Zhigang Ke, Yu Gao, Fang Sun, Xunmei Zhou, Fan Li, Jing Chen, Zhencheng Yan, Baohua Liu, Zhiming Zhu, Weidong Tong. Efficacy and safety analysis of laparoscopic Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus with low body mass index[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2017, 03(04): 208-214.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhfpydxbdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9605.2017.04.006

https://zhfpydxbdzzz.cma-cmc.com.cn/EN/Y2017/V03/I04/208

Figures/Tables 6

References 22

[1]	Ogurtsova K, da Rocha Fernandes JD, Huang Y, et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes research and clinical practice 2017, 128:40-50.
[2]	Cummings DE, Cohen RV: Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 kg/m². Diabetes care 2016, 39(6):924-933.
[3]	Baskota A, Li S, Dhakal N, et al. Bariatric Surgery for Type 2 Diabetes Mellitus in Patients with BMI <30 kg/m²: A Systematic Review and Meta-Analysis. PloS one 2015, 10(7):e0132335.
[4]	Xu Y, Wang LM, He J, et al. Prevalence and Control of Diabetes in Chinese Adults. Jama-J Am Med Assoc 2013, 310(9):948-958.
[5]	American Diabetes A: 2. Classification and Diagnosis of Diabetes. Diabetes care 2017, 40(1):11-24.
[6]	中国医师协会外科医师分会肥胖和糖尿病外科医师委员会.中国肥胖和2型糖尿病外科治疗指南（2014）[J].中国实用外科杂志，2014,34(11):1005-1010.
[7]	Low S, Chin MC, Ma S, et al. Rationale for redefining obesity in Asians. Annals of the Academy of Medicine, Singapore 2009, 38(1):66-69.
[8]	Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Annals of surgery 2003, 238(4):467-484.
[9]	Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric Surgery versus Intensive Medical Therapy for Diabetes - 5-Year Outcomes. The New England journal of medicine 2017, 376(7):641-651.
[10]	Razak F, Anand SS, Shannon H, et al. Defining obesity cut points in a multiethnic population. Circulation 2007, 115(16):2111-2118.
[11]	Chen Y, Corsino L, Shantavasinkul PC, et al. Gastric Bypass Surgery Leads to Long-term Remission or Improvement of Type 2 Diabetes and Significant Decrease of Microvascular and Macrovascular Complications. Annals of surgery 2016, 263(6):1138-1142.
[12]	Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet (London, England) 2015, 386(9997):964-973.
[13]	Pournaras DJ, le Roux CW. Type 2 diabetes: multimodal treatment of a complex disease. Lancet (London, England) 2015, 386(9997):936-937.
[14]	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. Obesity surgery 2010, 20(6):776-790.
[15]	Huang CK, Shabbir A, Lo CH, et al. Laparoscopic Roux-en-Y gastric bypass for the treatment of type II diabetes mellitus in Chinese patients with body mass index of 25-35. Obesity surgery 2011, 21(9):1344-1349.
[16]	Zhang H, Han X, Yu H, et al. Effect of Roux-en-Y Gastric Bypass on Remission of T2D: Medium-Term Follow-up in Chinese Patients with Different BMI Obesity Class. Obesity surgery 2017, 27(1):134-142.
[17]	Di J, Zhang H, Yu H, et al. Effect of Roux-en-Y gastric bypass on the remission of type 2 diabetes: a 3-year study in Chinese patients with a BMI <30 kg/m². Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery 2016, 12(7):1357-1363.
[18]	Cohen RV, Pinheiro JC, Schiavon CA, Salles JE, Wajchenberg BL, Cummings DE: Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes care 2012, 35(7):1420-1428.
[19]	Gong K, Li K, Zhang N, et al. Gastric bypass procedure for type 2 diabetes patients with BMI<28 kg/m². Surgical endoscopy 2017, 31(3):1172-1179.
[20]	Liang H, Guan W, Yang Y, et al. Roux-en-Y gastric bypass for Chinese type 2 diabetes mellitus patients with a BMI<28 kg/m²: a multi-institutional study. Journal of biomedical research 2015, 29(2):112-117.
[21]	Cui JF, Chen T, Shi L, et al. Gastric bypass surgery in non-obese patients with type 2 diabetes mellitus: a 1-year follow-up of 58 cases in Chinese. International journal of clinical and experimental medicine 2015, 8(3):4393-4398.
[22]	Yin J, Xu L, Mao Z, et al. Laparoscopic Roux-en-Y gastric bypass for type 2 diabetes mellitus in nonobese Chinese patients. Surgical laparoscopy, endoscopy & percutaneous techniques 2014, 24(6):e200-206.

分组	例数	性别（例）		年龄（岁）	病程（年）	空腹血糖(mmol/L)	HbA1c(%)	空腹C肽（nmol/L）	TC (mmol/L)	TG (mmol/L)	HDL (mmol/L)	LDL (mmol/L)
分组	例数	男	女	年龄（岁）	病程（年）	空腹血糖(mmol/L)	HbA1c(%)	空腹C肽（nmol/L）	TC (mmol/L)	TG (mmol/L)	HDL (mmol/L)	LDL (mmol/L)
BMI≤27.5kg/m²	28	13	15	48.5±7.5	5.6±3.9	8.1±3.2	8.1±1.9	1.26±1.21	4.7±1.2	2.5±2.3	1.2±0.6	2.6±0.6
BMI>27.5kg/m²	53	31	22	41.4±11.3	4.1±3.8	8.6±3.2	8.2±2	1.6±1.6	5.0±1.3	3.0±2.4	1.2±1.0	2.8±0.8
统计值	?	x²=1.074		F=8.074	F=0.21	F=0.062	F=0.016	F=0.002	F=0.064	F=0.01	F=0.486	F=0.699
P值	?	>0.05		<0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

分组	例数	性别（例）		年龄（岁）	病程（年）	空腹血糖(mmol/L)	HbA1c(%)	空腹C肽（nmol/L）	TC (mmol/L)	TG (mmol/L)	HDL (mmol/L)	LDL (mmol/L)
分组	例数	男	女	年龄（岁）	病程（年）	空腹血糖(mmol/L)	HbA1c(%)	空腹C肽（nmol/L）	TC (mmol/L)	TG (mmol/L)	HDL (mmol/L)	LDL (mmol/L)
BMI≤27.5kg/m²	28	13	15	48.5±7.5	5.6±3.9	8.1±3.2	8.1±1.9	1.26±1.21	4.7±1.2	2.5±2.3	1.2±0.6	2.6±0.6
BMI>27.5kg/m²	53	31	22	41.4±11.3	4.1±3.8	8.6±3.2	8.2±2	1.6±1.6	5.0±1.3	3.0±2.4	1.2±1.0	2.8±0.8
统计值	?	x²=1.074		F=8.074	F=0.21	F=0.062	F=0.016	F=0.002	F=0.064	F=0.01	F=0.486	F=0.699
P值	?	>0.05		<0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

HbA1c-no.（%）	BMI≤27.5kg/m² （n=15）	BMI>27.5kg/m² （n=25）	P value
≤ 6%- no.（%）	9（60）	14（56）	0.804
≤ 6.5%- no.（%）	11（73.3）	19（76）	0.850
≤ 7%- no.（%）	11（73.3）	24（96）	0.036

HbA1c-no.（%）	BMI≤27.5kg/m² （n=15）	BMI>27.5kg/m² （n=25）	P value
≤ 6%- no.（%）	9（60）	14（56）	0.804
≤ 6.5%- no.（%）	11（73.3）	19（76）	0.850
≤ 7%- no.（%）	11（73.3）	24（96）	0.036

HbA1c-no.（%）	BMI≤27.5kg/m² （n=12）	BMI>27.5kg/m² （n=20）	P value
≤ 6%- no.（%）	3（25）	6（30）	0.761
≤ 6.5%- no.（%）	7（58.3）	11（55）	0.854
≤ 7%- no.（%）	10（83.3）	18（90）	0.581

Please choose a citation manager

Content to export