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