Takeshi Naitoh1, Kazunori Kasama2, Yosuke Seki2, Masayuki Ohta3, Takashi Oshiro4, Akira Sasaki5, Yasuhiro Miyazaki6, Tsuyoshi Yamaguchi7, Hideki Hayashi8, Hirofumi Imoto9, Naoki Tanaka9, Michiaki Unno9. 1. Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan. naitot@surg1.med.tohoku.ac.jp. 2. Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan. 3. Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan. 4. Department of Surgery, Sakura Hospital, Toho University Medical Center, Sakura, Japan. 5. Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan. 6. Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. 7. Department of Surgery, Shiga University of Medical Science, Otsu, Japan. 8. Research Center for Frontier Medical Engineering, Chiba University, Chiba, Japan. 9. Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Abstract
BACKGROUND: The incidence of obesity with type 2 diabetes (T2DM) is increasing in Japan. The main bariatric surgery procedures in Japan are laparoscopic sleeve gastrectomy (LSG) and LSG with duodenal-jejunal bypass (LSG/DJB) because of the high incidence of gastric cancer and difficulty exploring a remnant stomach after gastric bypass. However, few studies have compared the antidiabetic effect of LSG/DJB with LSG alone. PURPOSE: The purpose of this study is to compare the antidiabetic effect of LSG/DJB with that of LSG alone in Japanese obese diabetic patients. METHODS: This was a retrospective multicenter study including 298 cases: 177 and 121 LSG and LSG/DJB cases, respectively. We investigated the antidiabetic effect of these two procedures at 12 months after surgery. Univariate and multivariate analyses were done to evaluate the predictive factors of T2DM remission. RESULTS: The diabetes remission rate at 12 months after surgery was 80.8% for LSG and 86.0% for LSG/DJB. Insulin use and HbA1c ≤ 6.7% were significant predictive factors in multivariate analysis for all patients. In patients with ABCD score ≥ 6, the diabetes remission rate was 94.8% and there was no difference between procedures. Only duration of diabetes and insulin use were significant predictive factors both in univariate and multivariate analyses. However, in cases with ABCD score ≤ 5, the remission rate was 70.3% and procedure type was the most significant predictive factor for diabetes remission (odds ratio [OR] 5.140). CONCLUSIONS: Although both LSG and LSG/DJB have good antidiabetic effects in Japanese obese patients, LSG/DJB is more effective for patients with lower ABCD scores.
BACKGROUND: The incidence of obesity with type 2 diabetes (T2DM) is increasing in Japan. The main bariatric surgery procedures in Japan are laparoscopic sleeve gastrectomy (LSG) and LSG with duodenal-jejunal bypass (LSG/DJB) because of the high incidence of gastric cancer and difficulty exploring a remnant stomach after gastric bypass. However, few studies have compared the antidiabetic effect of LSG/DJB with LSG alone. PURPOSE: The purpose of this study is to compare the antidiabetic effect of LSG/DJB with that of LSG alone in Japanese obese diabeticpatients. METHODS: This was a retrospective multicenter study including 298 cases: 177 and 121 LSG and LSG/DJB cases, respectively. We investigated the antidiabetic effect of these two procedures at 12 months after surgery. Univariate and multivariate analyses were done to evaluate the predictive factors of T2DM remission. RESULTS: The diabetes remission rate at 12 months after surgery was 80.8% for LSG and 86.0% for LSG/DJB. Insulin use and HbA1c ≤ 6.7% were significant predictive factors in multivariate analysis for all patients. In patients with ABCD score ≥ 6, the diabetes remission rate was 94.8% and there was no difference between procedures. Only duration of diabetes and insulin use were significant predictive factors both in univariate and multivariate analyses. However, in cases with ABCD score ≤ 5, the remission rate was 70.3% and procedure type was the most significant predictive factor for diabetes remission (odds ratio [OR] 5.140). CONCLUSIONS: Although both LSG and LSG/DJB have good antidiabetic effects in Japanese obesepatients, LSG/DJB is more effective for patients with lower ABCD scores.
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Authors: Yoshihiko Tashiro; Qinghong Han; Yuying Tan; Norihiko Sugisawa; Jun Yamamoto; Hiroto Nishino; Sachiko Inubushi; Y U Sun; Hyein Lim; Takeshi Aoki; Masahiko Murakami; Yoshihisa Takahashi; Michael Bouvet; Robert M Hoffman Journal: In Vivo Date: 2020 May-Jun Impact factor: 2.155