Clinical efficiency of metabolic surgery on type 2 diabetes mellitus patients with body mass index 27.5–32.5 kg/m<sup>2</sup>_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

JI Guangnian , ZHU Liyong , LI Pengzhou , YANG Xiangwu , LI Weizheng , SUN Xulong , QIU Xianjie , LI Rao ,  ZHU Shaihong

The Third Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha 410013, P. R. China;

Corresponding author：

ZHU Shaihong, Email: shzhu@mail.csu.edu.cn

Keywords：

metabolic surgery; type 2 diabetes mellitus; mild obesity

DOI：

10.7507/1007-9424.201712102

Video：

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Objective To investigate effect of metabolic surgery on type 2 diabetes mellitus (T2DM) patients with body mass index (BMI) 27.5–32.5 kg/m². Methods The clinical data of 43 T2DM patients with BMI 27.5–32.5 kg/m² underwent metabolic surgery from October 2014 to October 2016 in the Third Xiangya Hospital of Central South University were analyzed retrospectively. The related indexes such as BMI, blood glucose level, blood lipid level were analyzed before and after metabolic surgery. Results All the patients underwent metabolic surgery successfully. Among them, 35 cases underwent laparoscopic gastric bypass surgery while 8 cases underwent laparoscopic sleeve gastrectomy without related complications after operation. Compared with preoperative indexes, the BMI, fasting blood glucose, HbA1c, triglyceride, and total cholesterol on the postoperative different time were all significantly decreased (P<0.05) except for the HbA1c on the postoperative 1-week, the high density lipoprotein level on the postoperative 12-month was significantly increased (P<0.05). The OGTT 30, 60, and 120 min blood glucose levels on the postoperative 1-week and 3-month, and 60 and 120 min blood glucose levels on the postoperative 6-month and 12-month were all significantly decreased (P<0.05). The OGTT-IRT 60 min insulin level on the postoperative 3-month and the 30 min insulin levels on the postoperative 6- and 12-month were all significantly increased (P<0.05). The levels of OGTT-CRT 30 and 60 min C peptide on the postoperative 6-month and the level of 30 min C peptide on the postoperative 12-month were all significantly increased (P<0.05). Conclusions Metabolic surgery is effective in treatment of T2DM patients with BMI 27.5–32.5 kg/m², and levels of blood glucose and blood lipids can be improved significantly. Synthesis and release of insulin by islet cells can be ameliorated.

Citation： JI Guangnian, ZHU Liyong, LI Pengzhou, YANG Xiangwu, LI Weizheng, SUN Xulong, QIU Xianjie, LI Rao, ZHU Shaihong. Clinical efficiency of metabolic surgery on type 2 diabetes mellitus patients with body mass index 27.5–32.5 kg/m². CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(3): 271-275. doi: 10.7507/1007-9424.201712102 Copy

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2.	中华医学会外科学分会内分泌外科学组, 中华医学会外科学分会胃肠外科学组, 中华医学会外科学分会外科手术学学组, 等. 中国糖尿病外科治疗专家指导意见(2010). 中国实用外科杂志, 2011, 31(1): 54-58.
3.	Arterburn D, Schauer DP, Wise RE, et al. Change in predicted 10-year cardiovascular risk following laparoscopic Roux-en-Y gastric bypass surgery. Obes Surg, 2009, 19(2): 184-189.
4.	郑成竹, 邹大进, 丁丹. 2 型糖尿病外科治疗标准化临床路径——2 型糖尿病内外科诊疗流程. 中国实用外科杂志, 2013, 33(1): 17-18.
5.	朱利勇, 李鹏洲, 赵磊, 等. 腹腔镜 Roux-en-Y 胃旁路术治疗 2 型糖尿病的疗效及指标相关性分析. 中华肥胖与代谢病电子杂志, 2015, 1(2): 67-71.
6.	周玉龙, 韩晓东, 狄建忠, 等. Roux-en-Y 胃旁路术治疗 2 型糖尿病的研究进展. 中国普外基础与临床杂志, 2014, 21(2): 246-250.
7.	李滢旭, 方登华, 刘天锡. 3D 高清腹腔镜在减重代谢手术中的应用. 中国普外基础与临床杂志, 2017, 24(9): 1106-1111.
8.	Dixon JB, Zimmet P, Alberti KG, et al. Bariatric surgery: an IDF statement for obese type 2 diabetes. Arq Bras Endocrinol Metabol, 2011, 55(6): 367-382.
9.	Dixon JB, Hur KY, Lee WJ, et al. Gastric bypass in type 2 diabetes with BMI <30: weight and weight loss have a major influence on outcomes. Diabet Med, 2013, 30(4): e127-e134.
10.	程中, 杜潇. 2 型糖尿病外科治疗术式合理选择及评价. 中国实用外科杂志, 2014, 34(11): 1030-1032.
11.	Zhu L, Mo Z, Yang X, et al. Effect of laparoscopic Roux-en-Y gastroenterostomy with BMI<35 kg/m² in type 2 diabetes mellitus. Obes Surg, 2012, 22(10): 1562-1567.
12.	Wang G, Zhu L, Li W, et al. Can low BMI Chinese patients with type 2 diabetes benefit from laparoscopic Roux-en-Y gastric bypass surgery? Surg Obes Relat Dis, 2016, 12(10): 1890-1895.
13.	Espinosa O, Pineda O, Maydón HG, et al. Type 2 diabetes mellitus outcomes after laparoscopic gastric bypass in patients with BMI <35 kg/m ² using strict remission criteria: early outcomes of a prospective study among Mexicans. Surg Endosc, 2018, 32(3): 1353-1359.
14.	Horwitz D, Saunders JK, Ude-Welcome A, et al. Three-year follow-up comparing metabolic surgery versus medical weight management in patients with type 2 diabetes and BMI 30-35. The role of sRAGE biomarker as predictor of satisfactory outcomes. Surg Obes Relat Dis, 2016, 12(7): 1337-1341.
15.	Lee EY, Hwang S, Lee SH, et al. Postprandial C-peptide to glucose ratio as a predictor of β-cell function and its usefulness for staged management of type 2 diabetes. J Diabetes Investig, 2014, 5(5): 517-524.
16.	Caiazzo R, Zerrweck C, Verhaeghe R, et al. Gastric bypass and glucose metabolism. Diabetes Metab, 2009, 35(6 Pt 2): 528-531.
17.	Zerrweck C, Zurita L, Álvarez G, et al. Taste and olfactory changes following laparoscopic gastric bypass and sleeve gastrectomy. Obes Surg, 2016, 26(6): 1296-1302.
18.	Chakravartty S, Tassinari D, Salerno A, et al. What is the mechanism behind weight loss maintenance with gastric bypass? Curr Obes Rep, 2015, 4(2): 262-268.
19.	Papamargaritis D, Miras AD, le Roux CW. Influence of diabetes surgery on gut hormones and incretins. Nutr Hosp, 2013, 28 Suppl 2: 95-103.

1. 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). 中国实用外科杂志, 2014, 34(11): 1005-1010.
2. 中华医学会外科学分会内分泌外科学组, 中华医学会外科学分会胃肠外科学组, 中华医学会外科学分会外科手术学学组, 等. 中国糖尿病外科治疗专家指导意见(2010). 中国实用外科杂志, 2011, 31(1): 54-58.
3. Arterburn D, Schauer DP, Wise RE, et al. Change in predicted 10-year cardiovascular risk following laparoscopic Roux-en-Y gastric bypass surgery. Obes Surg, 2009, 19(2): 184-189.
4. 郑成竹, 邹大进, 丁丹. 2 型糖尿病外科治疗标准化临床路径——2 型糖尿病内外科诊疗流程. 中国实用外科杂志, 2013, 33(1): 17-18.
5. 朱利勇, 李鹏洲, 赵磊, 等. 腹腔镜 Roux-en-Y 胃旁路术治疗 2 型糖尿病的疗效及指标相关性分析. 中华肥胖与代谢病电子杂志, 2015, 1(2): 67-71.
6. 周玉龙, 韩晓东, 狄建忠, 等. Roux-en-Y 胃旁路术治疗 2 型糖尿病的研究进展. 中国普外基础与临床杂志, 2014, 21(2): 246-250.
7. 李滢旭, 方登华, 刘天锡. 3D 高清腹腔镜在减重代谢手术中的应用. 中国普外基础与临床杂志, 2017, 24(9): 1106-1111.
8. Dixon JB, Zimmet P, Alberti KG, et al. Bariatric surgery: an IDF statement for obese type 2 diabetes. Arq Bras Endocrinol Metabol, 2011, 55(6): 367-382.
9. Dixon JB, Hur KY, Lee WJ, et al. Gastric bypass in type 2 diabetes with BMI <30: weight and weight loss have a major influence on outcomes. Diabet Med, 2013, 30(4): e127-e134.
10. 程中, 杜潇. 2 型糖尿病外科治疗术式合理选择及评价. 中国实用外科杂志, 2014, 34(11): 1030-1032.
11. Zhu L, Mo Z, Yang X, et al. Effect of laparoscopic Roux-en-Y gastroenterostomy with BMI<35 kg/m² in type 2 diabetes mellitus. Obes Surg, 2012, 22(10): 1562-1567.
12. Wang G, Zhu L, Li W, et al. Can low BMI Chinese patients with type 2 diabetes benefit from laparoscopic Roux-en-Y gastric bypass surgery? Surg Obes Relat Dis, 2016, 12(10): 1890-1895.
13. Espinosa O, Pineda O, Maydón HG, et al. Type 2 diabetes mellitus outcomes after laparoscopic gastric bypass in patients with BMI <35 kg/m ² using strict remission criteria: early outcomes of a prospective study among Mexicans. Surg Endosc, 2018, 32(3): 1353-1359.
14. Horwitz D, Saunders JK, Ude-Welcome A, et al. Three-year follow-up comparing metabolic surgery versus medical weight management in patients with type 2 diabetes and BMI 30-35. The role of sRAGE biomarker as predictor of satisfactory outcomes. Surg Obes Relat Dis, 2016, 12(7): 1337-1341.
15. Lee EY, Hwang S, Lee SH, et al. Postprandial C-peptide to glucose ratio as a predictor of β-cell function and its usefulness for staged management of type 2 diabetes. J Diabetes Investig, 2014, 5(5): 517-524.
16. Caiazzo R, Zerrweck C, Verhaeghe R, et al. Gastric bypass and glucose metabolism. Diabetes Metab, 2009, 35(6 Pt 2): 528-531.
17. Zerrweck C, Zurita L, Álvarez G, et al. Taste and olfactory changes following laparoscopic gastric bypass and sleeve gastrectomy. Obes Surg, 2016, 26(6): 1296-1302.
18. Chakravartty S, Tassinari D, Salerno A, et al. What is the mechanism behind weight loss maintenance with gastric bypass? Curr Obes Rep, 2015, 4(2): 262-268.
19. Papamargaritis D, Miras AD, le Roux CW. Influence of diabetes surgery on gut hormones and incretins. Nutr Hosp, 2013, 28 Suppl 2: 95-103.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical efficiency of metabolic surgery on type 2 diabetes mellitus patients with body mass index 27.5–32.5 kg/m²

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical efficiency of metabolic surgery on type 2 diabetes mellitus patients with body mass index 27.5–32.5 kg/m2

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Clinical efficiency of metabolic surgery on type 2 diabetes mellitus patients with body mass index 27.5–32.5 kg/m²