Hui Liang1, Qing Cao2, Huan Liu1, Wei Guan1, Claudia Wong3, Daniel Tong4. 1. Department of Surgery, The First Affiliated Hospital of Nan Jing Medical University, Nanjing, Jiangsu, People's Republic of China. 2. Department of General Surgery, Affiliated Hospital of Nantong University, Nantong, People's Republic of China. 3. Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China. 4. Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China. Danielkhtong@gmail.com.
Abstract
INTRODUCTION: Roux-en-Y gastric bypass has been proven to be beneficial for patients with obesity and type 2 diabetes mellitus (T2DM). In less-obese patient (BMI 30-35 kg/m2), surgical treatment is indicated when medication fails to control the T2DM. Asian develops diabetes at a lower BMI. For lower-BMI patients, the rate of diabetes amelioration varies significantly with patients of higher BMI after surgical treatment. The factors that contribute to the post-operative diabetes response rate in lower-BMI patients have not been elucidated. METHODS: Between 2010 and 2014, a total of 144 patients who underwent gastric bypass for the treatment of T2DM were included for study. Patients were divided into two groups for subgroup analysis, namely BMI > 30 kg/m2 and BMI < 30 kg/m2. Factors affecting the remission rate were examined. RESULTS: Of the studied patients, the DM remission rate for the high-BMI group (BMI > 30 kg/m2) was 80% (n = 90) whereas for the lower BMI (BMI < 30 kg/m2) was 50% (n = 54), p < 0.001. For high-BMI group, low HbA1c and high fasting C-peptide are predictive factors whereas for lower-BMI group, along with elevated C-peptide level, disease duration is the positive predictive factor for DM remission. CONCLUSION: Patients with BMI > 30 kg/m2 and those with BMI < 30 kg/m2 have distinct remission predicting factors. Low HbA1c is a predictor of remission in low-high-BMI patients while duration of diabetes is for high-low-BMI patients. C-peptide is a predictor of remission in both groups. Further large-scale studies are required to define the predictors of diabetes remission after gastric bypass in low- and high-BMI patients.
INTRODUCTION: Roux-en-Y gastric bypass has been proven to be beneficial for patients with obesity and type 2 diabetes mellitus (T2DM). In less-obesepatient (BMI 30-35 kg/m2), surgical treatment is indicated when medication fails to control the T2DM. Asian develops diabetes at a lower BMI. For lower-BMI patients, the rate of diabetes amelioration varies significantly with patients of higher BMI after surgical treatment. The factors that contribute to the post-operative diabetes response rate in lower-BMI patients have not been elucidated. METHODS: Between 2010 and 2014, a total of 144 patients who underwent gastric bypass for the treatment of T2DM were included for study. Patients were divided into two groups for subgroup analysis, namely BMI > 30 kg/m2 and BMI < 30 kg/m2. Factors affecting the remission rate were examined. RESULTS: Of the studied patients, the DM remission rate for the high-BMI group (BMI > 30 kg/m2) was 80% (n = 90) whereas for the lower BMI (BMI < 30 kg/m2) was 50% (n = 54), p < 0.001. For high-BMI group, low HbA1c and high fasting C-peptide are predictive factors whereas for lower-BMI group, along with elevated C-peptide level, disease duration is the positive predictive factor for DM remission. CONCLUSION:Patients with BMI > 30 kg/m2 and those with BMI < 30 kg/m2 have distinct remission predicting factors. Low HbA1c is a predictor of remission in low-high-BMI patients while duration of diabetes is for high-low-BMI patients. C-peptide is a predictor of remission in both groups. Further large-scale studies are required to define the predictors of diabetes remission after gastric bypass in low- and high-BMI patients.
Entities:
Keywords:
Gastric bypass; Obese; Predictive factors; Type 2 diabetes
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