Effect of Laparoscopic Gastric Bypass on Obesity Related Type 2 Diabetes_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HANG Xiaojuan ¹ , DU Juan ² , DU Xiao ³ , LI Yang ³ , CHENG Zhong ³ ,  TIAN Haoming. ²

1. Laboratory of Endocrinology and Metabolism， West China Hospital of Sichuan University， Chengdu 610041， Sichuan Province， China;;
2. Department of Endocrinology and Metabolism， West China Hospital of Sichuan University， Chengdu 610041， Sichuan Province， China;;
3. Department of Gastrointestinal Surgery， West China Hospital of Sichuan University， Chengdu 610041， Sichuan Province， China;

Corresponding author：

TIAN Haoming., Email: hmtian999@yahoo.com.cn

Keywords：

Gastric bypass; Obesity; Type 2 diabetes mellitus

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Objective 　To investigate the short term and long term effects of laparoscopic gastric bypass on obesity related type 2 diabetes.
Methods 　Twenty obese patients with type 2 diabetes underwent laparoscopic gastric bypass between Nov. 2009 and Feb. 2012 were identified in the computer database of West China Hospital of Sichuan University. All patients had short term follow-up of less than 1 year and among them 11 were with long term follow-up of 1 year or more. Body weight， body mass index （BMI）， blood glucose， glycosylated hemoglobin （HbA1c）， homeostasis model assessment of insulin resistance-insulin resistance （HOMA-IR）， blood pressure， and blood lipids were examined. Short term （＜1 year） and long term （≥1 year） remission rates of diabetes were calculated and factors which might have effects on the remission of diabetes were analyzed.
Results 　Of patients with short term follow-up，body weight， fasting plasma glucose （FPG）， 2h plasma glucose （2hPG）， HbA1c， and HOMA-IR were reduced significantly. Among them， 18 of 20 patients （90.0%） reached the glucose and medication standards of complete remission and partial remission， 9 patients were defined as completely remitted （9/20， 45.0%）. Those accompanied with hypertension and （or） hyperlipemia were all improved clinically. The duration of diabetes， fasting and 2 h C peptide were found to be related to short term diabetes remission. Patients with long term follow-up of 1 year or more were observed to have significant reductions in body weight， FPG， 2hPG， HbA1c， and HOMA-IR as well. Hypertension and hyperlipidemia were all well controlled. The remission rate of diabetes reached 9/11 （81.8%）and those who were defined as completely remitted took a proportion of 6/11 （54.5%）. In these patients， those who did not reach the standards of complete remission had longer duration of diabetes and higher FPG when compared with those who did. No severe adverse event was found during the follow-up in either group. Most patients investigated were satisfied with the surgery.
Conclusion 　Laparoscopic gastric bypass is effective and safe on short term and long term treatment of obesity related type 2 diabetes.

Citation： HANG Xiaojuan,DU Juan,DU Xiao,LI Yang,CHENG Zhong,TIAN Haoming.. Effect of Laparoscopic Gastric Bypass on Obesity Related Type 2 Diabetes. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(12): 1272-1277. doi: Copy

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2.	Pories WJ， Swanson MS， MacDonald KG， et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus[J] . Ann Surg， 1995， 222(3)：339-352.
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7.	Buse JB， Caprio S， Cefalu WT， et al. How do we define cure of diabetes?[J]. Diabetes Care，2009，32(11)：2133-2135.
8.	Matthews DR， Hosker JP， Rudenski AS， et al. Homeostasis model assessment：insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man[J]. Diabetologia，1985，28(7)：412-419.
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12.	Sugerman HJ， Wolfe LG， Sica DA， et al. Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss[J]. Ann Surg， 2003， 237(6)：751-758.
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14.	Kasama K， Mui W， Lee WJ， et al. IFSO-APC consensus statements 2011[J]. Obes Surg， 2012， 22(5)：677-684.
15.	Peluso L， Vanek VW. Efficacy of gastric bypass in the treatment of obesity-related comorbidities[J]. Nutr Clin Pract， 2007， 22(1)：22-28.
16.	Patriti A， Facchiano E， Sanna A， et al. The enteroinsular axis and the recovery from type 2 diabetes after bariatric surgery[J]. Obes Surg， 2004， 14(6)：840-848.
17.	Thomas S， Schauer P. Bariatric surgery and the gut hormoneresponse[J]. Nutr Clin Pract， 2010， 25(2)：175-182.
18.	Mingrone G， Castagneto-Gissey L. Mechanisms of earlyimprovement/resolution of type 2 diabetes after bariatric surgery[J]. Diabetes Metab， 2009， 35(6 Pt 2)：518-523.
19.	Caiazzo R， Zerrweck C， Verhaeghe R， et al. Gastric bypass and glucose metabolism[J]. Diabetes Metab， 2009， 35(6 Pt 2)：528-531.
20.	O’Brien PE. Bariatric surgery：mechanisms， indications andoutcomes[J]. J Gastroenterol Hepatol， 2010， 25(8)：1358-1365.
21.	Dixon JB， Pories WJ， O’Brien PE， et al. Surgery as an effectiveearly intervention for diabesity：why the reluctance?[J].Diabetes Care， 2005， 28(2)：472-474.
22.	Hall TC， Pellen MG， Sedman PC， et al. Preoperative factors predicting remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass surgery for obesity[J]. Obes Surg， 2010， 20(9)：1245-1250.
23.	Schauer PR， Kashyap SR， Wolski K， et al. Bariatric surgeryversus intensive medical therapy in obese patients with diabetes[J]. N Engl J Med， 2012， 366(17)：1567-1576.
24.	Mingrone G， Panunzi S， De Gaetano A， et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes[J]. N Engl J Med， 2012， 366(17)：1577-1585.
25.	Carlsson LM， Peltonen M， Ahlin S， et al. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects[J]. N Engl J Med， 2012， 367(8)：695-704.

1. Pories WJ， MacDonald KG Jr， Flickinger EG， et al. Is typeⅡdiabetes mellitus (NIDDM) a surgical disease?[J]. Ann Surg， 1992， 215(6)：633-643.
2. Pories WJ， Swanson MS， MacDonald KG， et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus[J] . Ann Surg， 1995， 222(3)：339-352.
3. Dixon JB， le Roux CW， Rubino F， et al. Bariatric surgery for type 2 diabetes[J]. Lancet， 2012， 379(9833)：2300-2311.
4. Varela JE. Bariatric surgery：a cure for diabetes?[J]. Curr Opin Clin Nutr Metab Care， 2011， 14(4)：396-401.
5. Schauer PR， Burguera B， Ikramuddin S， et al. Effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus[J]. Ann Surg， 2003， 238(4)：467-485.
6. Buchwald H， Estok R， Fahrbach K， et al. Weight and type 2 diabetes after bariatric surgery：systematic review and meta-analysis[J]. Am J Med，2009， 122(3)：248-256.
7. Buse JB， Caprio S， Cefalu WT， et al. How do we define cure of diabetes?[J]. Diabetes Care，2009，32(11)：2133-2135.
8. Matthews DR， Hosker JP， Rudenski AS， et al. Homeostasis model assessment：insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man[J]. Diabetologia，1985，28(7)：412-419.
9. McMahon MM， Sarr MG， Clark MM， et al. Clinical management after bariatric surgery：value of a multidisciplinary approach[J]. Mayo Clin Proc，2006，81(10 Suppl)：S34-S45.
10. Sjöström L， Lindroos AK， Peltonen M， et al. Lifestyle， diabetes，and cardiovascular risk factors 10 years after bariatric surgery[J]. N Engl J Med， 2004， 351(26)：2683-2693.
11. Kim S， Richards WO. Long-term follow-up of the metabolicprofiles in obese patients with type 2 diabetes mellitus after Roux-en-Ygastric bypass[J]. Ann Surg， 2010， 251(6)：1049-1055.
12. Sugerman HJ， Wolfe LG， Sica DA， et al. Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss[J]. Ann Surg， 2003， 237(6)：751-758.
13. American Diabetes Association. Standards of medical care indiabetes——2009[J]. Diabetes Care， 2009， 32 Suppl 1：S13-S61.
14. Kasama K， Mui W， Lee WJ， et al. IFSO-APC consensus statements 2011[J]. Obes Surg， 2012， 22(5)：677-684.
15. Peluso L， Vanek VW. Efficacy of gastric bypass in the treatment of obesity-related comorbidities[J]. Nutr Clin Pract， 2007， 22(1)：22-28.
16. Patriti A， Facchiano E， Sanna A， et al. The enteroinsular axis and the recovery from type 2 diabetes after bariatric surgery[J]. Obes Surg， 2004， 14(6)：840-848.
17. Thomas S， Schauer P. Bariatric surgery and the gut hormoneresponse[J]. Nutr Clin Pract， 2010， 25(2)：175-182.
18. Mingrone G， Castagneto-Gissey L. Mechanisms of earlyimprovement/resolution of type 2 diabetes after bariatric surgery[J]. Diabetes Metab， 2009， 35(6 Pt 2)：518-523.
19. Caiazzo R， Zerrweck C， Verhaeghe R， et al. Gastric bypass and glucose metabolism[J]. Diabetes Metab， 2009， 35(6 Pt 2)：528-531.
20. O’Brien PE. Bariatric surgery：mechanisms， indications andoutcomes[J]. J Gastroenterol Hepatol， 2010， 25(8)：1358-1365.
21. Dixon JB， Pories WJ， O’Brien PE， et al. Surgery as an effectiveearly intervention for diabesity：why the reluctance?[J].Diabetes Care， 2005， 28(2)：472-474.
22. Hall TC， Pellen MG， Sedman PC， et al. Preoperative factors predicting remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass surgery for obesity[J]. Obes Surg， 2010， 20(9)：1245-1250.
23. Schauer PR， Kashyap SR， Wolski K， et al. Bariatric surgeryversus intensive medical therapy in obese patients with diabetes[J]. N Engl J Med， 2012， 366(17)：1567-1576.
24. Mingrone G， Panunzi S， De Gaetano A， et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes[J]. N Engl J Med， 2012， 366(17)：1577-1585.
25. Carlsson LM， Peltonen M， Ahlin S， et al. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects[J]. N Engl J Med， 2012， 367(8)：695-704.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of Laparoscopic Gastric Bypass on Obesity Related Type 2 Diabetes

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