Effect of laparoscopic mini-gastric bypass for type 2 diabetes mellitus: comparison of BMI>35 and <35 kg/m2.
BACKGROUND
Laparoscopic gastric bypass resulted in significant weight loss and resolution of type 2 diabetes mellitus (T2DM). The current indication for bariatric surgery is mainly applied for patients with body mass index (BMI)>35 kg/m2 with comorbidity status. However, little is known concerning T2DM patients with BMI<35 kg/m2. Recent studies have suggested that T2DM patients with BMI<35 kg/m2 might benefit from gastric bypass surgery.


METHODS
From Jan 2002 to Dec 2006, 820 patients who underwent laparoscopic mini-gastric bypass were enrolled in a surgically supervised weight loss program. We identified 201 (24.5%) patients who had impaired fasting glucose or T2DM. All the clinical data were prospectively collected and stored. Patients with BMI<35 kg/m2 were compared with those of BMI>35 kg/m2. Successful treatment of T2DM was defined by HbA1C<7.0%, LDL<100 mg/dl, and triglyceride<150 mg/dl.


RESULTS
Among the 201 patients, 44 (21.9%) had BMI<35 kg/m2, and 114 (56.7%) had BMI between 35 and 45, 43 (21.4%) had BMI>45 kg/m2. Patients with BMI<35 kg/m2 are significantly older, female predominant, had lower liver enzyme and C-peptide levels than those with BMI>35 kg/m2. The mean total weight loss for the population was 32.1, 33.4, 31.9, and 32.8% (at 1, 2, 3, 5 years after surgery), and percentage to change in BMI was 31.9, 34.2, 32.2, and 29.5% at 1, 2, 3, and 5 years. One year after surgery, fasting plasma glucose returned to normal in 89.5% of BMI<35 kg/m2 T2DM and 98.5% of BMI>35 kg/m2 patients (p=0.087). The treatment goal of T2DM (HbA1C<7.0%, LDL<150 mg/dl and triglyceride<150 mg/dl) was met in 76.5% of BMI<35 kg/m2 and 92.4% of BMI>350 kg/m2 (p=0.059).


CONCLUSIONS
Laparoscopic gastric bypass resulted in significant and sustained weight loss with successful treatment of T2DM up to 87.1%. Despite a slightly lower response rate of T2DM treatment, patients with BMI <35 still had an acceptable DM resolution, and this treatment option can be offered to this group of patients.
Lee
Wei-Jei
WJ
Department of Surgery, Min-Sheng General Hospital, and Department of International Business, Ching Yun University, Taoyuan, Taiwan, Republic of China. wjlee_obessurg_tw@yahoo.com.tw
Wang
Weu
W
Lee
Yi-Chih
YC
Huang
Ming-Te
MT
Ser
Kong-Han
KH
Chen
Jung-Chien
JC
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D015431:Weight Loss
D001786:Blood Glucose; D006442:Glycated Hemoglobin