title: Amelioration of insulin requirement in patients undergoing duodenal bypass for reasons other than obesity implicates foregut factors in the pathophysiology of type II diabetes.
abstract: BACKGROUND
  Foregut diversion and weight loss have been proposed as potential mechanisms for resolution of type II diabetes mellitus (T2DM) observed in patients undergoing gastric bypass for obesity. To support or refute the role of the foregut, we analyzed glycemic control in T2DM patients before and after foregut bypass for reasons other than morbid obesity.
  
  
  METHODS
  Using ICD9/CPT codes, we identified patients undergoing Roux-en-Y gastrojejunostomy (RY) or Billroth II (BII) reconstruction over 10 years. Fasting blood glucose, insulin or oral diabetic agent requirement, and body mass index (BMI) before and after surgery were tabulated and compared using the Student's t-test. Linear regression was applied to determine specific factors predictive of resolution or improvement in glycemic control including age, duration of diabetes, antidiabetic regimen, type of operation, and surgical indication.
  
  
  RESULTS
  Between 1996 and 2006, we identified 24 patients with T2DM out of a cohort of 209 who underwent either RY (12 of 24) or BII reconstruction (12 of 24) for cancer or peptic ulcer disease and survived more than 30 days after operation. Of this group, 75% were overweight (18 of 24 with BMI < 30 kg/m(2)) and 25% were class I morbidly obese (6 of 24 with BMI 30 to 35 kg/m(2)). Seventeen patients (71%) had either complete resolution (7 of 24 or 29%) or significant reduction (10 of 24 or 42%) in medication requirements; 7 patients (29%) did not have any improvement. Logistic regression failed to identify specific factors predicting improved glycemic control.
  
  
  CONCLUSIONS
  Complete resolution of T2DM in patients undergoing duodenal diverting surgery occurs in about one-third of nonobese patients. Improved glycemic control occurs in more than two-thirds and cannot be explained by surgically related weight loss alone. Surgical cure of T2DM may be possible in carefully selected nonobese patients.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, East Carolina University, Greenville, NC, USA.
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Zervos
authors.forename: Steven C
authors.initials: SC
authors.lastname: Agle
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Warren
authors.forename: Christina G
authors.initials: CG
authors.lastname: Lang
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Fitzgerald
authors.forename: Moahad
authors.initials: M
authors.lastname: Dar
authors.forename: Michael F
authors.initials: MF
authors.lastname: Rotondo
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Pories
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control*; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000378:metabolism / Q000601:surgery; D012189:Retrospective Studies; D013270:Stomach / Q000503:physiopathology; D015431:Weight Loss / Q000502:physiology*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin