Original article
Predictors of remission of type 2 diabetes mellitus in obese patients after gastrointestinal surgery

https://doi.org/10.1016/j.orcp.2012.08.190Get rights and content

Summary

Background

Gastroenterology is a beneficial treatment of morbidly obese type 2 diabetes mellitus (T2DM). We aimed to identify the predictors for the treatment of T2DM obese patients.

Methods

A retrospective study consisting of 531 patients undergoing laparoscopic gastric banding (LGB), laparoscopic mini-gastric bypass (LMGB) and laparoscopic sleeve gastrectomy (LSG) from January 2004 to May 2007 was performed. Patients with preoperative fasting serum glucose concentration of more than 126 mg/dl were diagnosed as T2DM. A postoperatively fasting serum glucose level of less than 110 mg/dl was considered to be remission of T2DM.

Results

Of the 531 patients, 62 (11.6%) were diagnosed as T2DM, including 23 men and 39 women, with a mean age of 31.8 ± 9.2 years, and a mean body mass index (BMI) of 40.0 kg/m2. The mean glucose at 3, 6, and 12 months after surgery were 100.1 mg/dl, 95.1 mg/dl and 91.8 mg/dl, respectively. The mean body weight loss one year after surgery was 9.4% for LGB, 31.4% for LSG and 37.1% for LMGB, respectively. Among these operation methods (LGB, LMGB and LSG), the BMI, body weight, waist circumference, serum lipid profile and serum factors associated with glucose metabolism were significantly different during the one-year postoperative follow-up. Remission rate of T2DM was achieved in 84.8%, 58.8% and 58.3% of patients for LMGB, LGB and LSG, respectively. The best operative method for the remission of T2DM was LMGB. Using an artificial neural network (ANN) data mining technique, waist circumference, operative methods and C-peptide were significantly predictors for the remission of T2 DM.

Conclusion

One year after gastrointestinal surgery, improvement of serum lipid profiles and serum data related to glucose metabolism in the different operative methods were noticed. LMGB seems to be the most effective procedure for the reduction of serum glucose levels compared with LAGB and LSG.

Introduction

Obesity and type 2 diabetes mellitus (T2DM) are two pan-endemic health problems in developed countries. Both diseases are very difficult to control with current medical treatment, including by diet, drug therapy and/or behavioral modification [1], [2], [3], [4], [5]. Gastrointestinal surgery can not only lead to weight loss, but also cure most of the associated medical diseases, especially T2DM, in morbidly obese patients [6], [7], [8], [9], [10], [11].

The principle of gastrointestinal surgery is gastrointestinal diversion, which involves changing the digestive tract hormonal status [12]. The weight reduction effect of different operation procedures including laparoscopic mini-gastric banding (LMGB), laparoscopic gastric bypass (LGB) and laparoscopic sleeve gastrectomy (LSG) was proven to have good results [13], [14]. In this study, we aimed to identify the predictive factors for the remission of T2DM in obese patients in three different operative procedures.

Section snippets

Eligibility

From January 2004 to May 2007, a total of 531 obese patients who selected different operative methods (LMGB, LGB or LSG) individually at our hospital participated in this study. Patients with a fasting serum glucose concentration greater than 126 mg/dl were considered to be type 2 diabetes mellitus (T2DM). All these patients had their anthropometric data and fasting blood sugar and insulin levels measured both pre- and post-operatively. We considered the remission of T2DM when the postoperative

Results

Overall, 62 out of 531 patients (11.6%) were diagnosed as T2DM in this study. Of these 62 patients, 23 were men, and 39 were women; their mean age was 31.8 ± 9.2 (18–64 years), their mean body weight (BW) was 109.7 kg (56–226 kg) and their mean body mass index (BMI) was 40.0 kg/m2 (30.0–77.0 kg/m2). Table 1 showed the preoperative clinical variables of our study cohort.

The excess weight loss [EWL, in percentage (%)] was 37.9%, 49.8% and 62.8% at 3, 6 and 12 months postoperatively, respectively. The

Discussion

In this study, we aimed to evaluate the significant predictive factors of body weight loss and reduction of serum fasting glucose in an obese population undergoing gastrointestinal surgery. Among three different operation methods (LGB, LMGB and LSG), the significant one-year postoperative follow-up factors were BMI, body weight, waist circumference, serum lipid profile (cholesterol, LDL-C and triglyceride) and serum factors related to diabetes mellitus (insulin, C-peptide, HbA1c and HOMA-IR).

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