OBJECTIVE: Surprisingly, 40% to 95% of patients with type 2 diabetes mellitus (T2DM) show early remission of hyperglycemia after obesity surgery. It is unknown to what extent other diabetes-associated comorbidities such as distal peripheral neuropathy (DPN) might be influenced by obesity surgery. This pilot study aimed at providing further evidence for the impact of Roux-en-Y gastric bypass (RYGB) on both glycemic control and DPN in non-severely obese patients with insulin-dependent T2DM. METHODS: In the present prospective cohort study, 20 patients with long-standing, insulin-dependent T2DM and a body mass index (BMI) between 25 and 35 kg/m underwent laparoscopic RYGB. Body mass index, glycosylated hemoglobin (HbA1c), and DPN [quantified by the Neuropathy Symptom Score (NSS) and the Neuropathy Deficit Score (NDS)] were investigated. RESULTS: Six months after surgery, the preoperative BMI of 32.8 ± 2.1 kg/m (mean ± standard deviation) dropped to 25.6 ± 2.5 kg/m (P < 0.001). Preoperative HbA1c levels decreased from 8.5 ± 1.2% to 7.1 ± 1.2% (P < 0.001), with 15% of patients having a normalized HbA1c level lower than 6.2%. Of 12 patients with documented DPN, the median NSS was 8 (range, 0-10) preoperatively and 0 (range, 0-9) postoperatively (P = 0.004), with 8 patients scoring an NSS of 0. The median NDS was 6 (range, 2-8) preoperatively and 4 (range, 0-8) postoperatively (P = 0.027), with 1 patient scoring an NDS of 0. All patients had an improvement or normalization in either 1 or both scores. CONCLUSIONS: As expected, BMI and HbA1c levels improved significantly after RYGB. More interestingly, neuropathy scores, such as NSS and NDS, improved significantly early after surgery. Symptomatic neuropathy was completely reversible in 67% of the patients. These findings add further evidence to the fact that RYGB might be a valuable treatment option not only for improving glycemic control but also for reducing diabetes-associated comorbidities, such as DPN. This points to a complex metabolic effect of RYGB that exceeds glucose normalization. However, the results still need to be confirmed in controlled trials.
OBJECTIVE: Surprisingly, 40% to 95% of patients with type 2 diabetes mellitus (T2DM) show early remission of hyperglycemia after obesity surgery. It is unknown to what extent other diabetes-associated comorbidities such as distal peripheral neuropathy (DPN) might be influenced by obesity surgery. This pilot study aimed at providing further evidence for the impact of Roux-en-Y gastric bypass (RYGB) on both glycemic control and DPN in non-severely obesepatients with insulin-dependent T2DM. METHODS: In the present prospective cohort study, 20 patients with long-standing, insulin-dependent T2DM and a body mass index (BMI) between 25 and 35 kg/m underwent laparoscopic RYGB. Body mass index, glycosylated hemoglobin (HbA1c), and DPN [quantified by the Neuropathy Symptom Score (NSS) and the Neuropathy Deficit Score (NDS)] were investigated. RESULTS: Six months after surgery, the preoperative BMI of 32.8 ± 2.1 kg/m (mean ± standard deviation) dropped to 25.6 ± 2.5 kg/m (P < 0.001). Preoperative HbA1c levels decreased from 8.5 ± 1.2% to 7.1 ± 1.2% (P < 0.001), with 15% of patients having a normalized HbA1c level lower than 6.2%. Of 12 patients with documented DPN, the median NSS was 8 (range, 0-10) preoperatively and 0 (range, 0-9) postoperatively (P = 0.004), with 8 patients scoring an NSS of 0. The median NDS was 6 (range, 2-8) preoperatively and 4 (range, 0-8) postoperatively (P = 0.027), with 1 patient scoring an NDS of 0. All patients had an improvement or normalization in either 1 or both scores. CONCLUSIONS: As expected, BMI and HbA1c levels improved significantly after RYGB. More interestingly, neuropathy scores, such as NSS and NDS, improved significantly early after surgery. Symptomatic neuropathy was completely reversible in 67% of the patients. These findings add further evidence to the fact that RYGB might be a valuable treatment option not only for improving glycemic control but also for reducing diabetes-associated comorbidities, such as DPN. This points to a complex metabolic effect of RYGB that exceeds glucose normalization. However, the results still need to be confirmed in controlled trials.
Authors: Adrian T Billeter; Pascal Probst; Lars Fischer; Jonas Senft; Hannes G Kenngott; Thilo Schulte; Gabriella Clemens; Ulrike Zech; Markus W Büchler; Peter P Nawroth; Beat P Müller-Stich Journal: Obes Surg Date: 2015-11 Impact factor: 4.129
Authors: Adrian T Billeter; Stefan Kopf; Martin Zeier; Katharina Scheurlen; Lars Fischer; Thilo M Schulte; Hannes G Kenngott; Barbara Israel; Philipp Knefeli; Markus W Büchler; Peter P Nawroth; Beat P Müller-Stich Journal: Dtsch Arztebl Int Date: 2016-12-09 Impact factor: 5.594
Authors: Martin Wagner; Benjamin Friedrich Berthold Mayer; Sebastian Bodenstedt; Katherine Stemmer; Arash Fereydooni; Stefanie Speidel; Rüdiger Dillmann; Felix Nickel; Lars Fischer; Hannes Götz Kenngott Journal: Surg Endosc Date: 2018-03-05 Impact factor: 4.584
Authors: Adrian T Billeter; Spiros Vittas; Barbara Israel; Katharina M Scheurlen; Asa Hidmark; Thomas H Fleming; Stefan Kopf; Markus W Büchler; Beat P Müller-Stich Journal: Langenbecks Arch Surg Date: 2017-07-09 Impact factor: 3.445
Authors: F S Wehrtmann; J R de la Garza; K F Kowalewski; M W Schmidt; K Müller; C Tapking; P Probst; M K Diener; L Fischer; B P Müller-Stich; F Nickel Journal: Obes Surg Date: 2020-02 Impact factor: 4.129
Authors: Felix Nickel; Christian Tapking; Laura Benner; Janina Sollors; Adrian T Billeter; Hannes G Kenngott; Loay Bokhary; Mathias Schmid; Moritz von Frankenberg; Lars Fischer; Sebastian Mueller; Beat P Müller-Stich Journal: Obes Surg Date: 2018-05 Impact factor: 4.129
Authors: Felix Nickel; Christian Tapking; Laura Benner; Svenja Schüler; Gregor B Ottawa; Katja Krug; Beat P Müller-Stich; Lars Fischer Journal: Obes Surg Date: 2019-07 Impact factor: 4.129