Metabolic surgery: roux-en-Y gastric bypass and variables associated with diabetes remission in patients with BMI <35.
Metabolic results of bariatric surgery have determined an expansion of its traditional indications, being increasingly performed in non-severely obese patients, especially in type 2 diabetes mellitus (T2DM). Our aim is to determine the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) in T2DM remission in patients with body mass index (BMI) below 35 kg/m(2) and the variables associated with T2DM remission after surgery. Retrospective analysis of diabetic patients with BMI <35 kg/m(2) who underwent LRYGB in our center between 2002 and 2010 was done. We analyzed patient's demographics, comorbidities, BMI, excess weight loss percentage (EWLp), complications, and metabolic results at 3 years. Univariate and multivariate analyses were performed to determine variables associated with T2DM remission. One hundred patients were included. Sixty patients (60 %) were women; median age was 48 years old (interquartile range (IQR) 42-54), and median preoperative BMI was 32.7 kg/m(2) (IQR 31.6-34.1). Median preoperative duration of T2DM was 4 years (IQR 2-7), with 49, 30, 2, and 18 % on treatment with one, two, and three hypoglycemic agents and insulin, respectively. Ninety-four percent achieved 36-month follow-up, and at this time, median EWLp was 93 % (IQR 67-121). A total of 53.2, 9.6, 25.5, and 11.7 % achieved a T2DM complete remission, partial remission, improvement, and no improvement, respectively. T2DM remission only was associated with non-insulin use in multivariate analysis, with an OR = 15.1 (2.8-81.2) and p = 0.002. LRYGB is a reliable and effective treatment in diabetic patients with a BMI <35 kg/m(2) at 3 years. T2DM remission's best results are observed in non-insulin diabetic patients.
Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, Región Metropolitana, Santiago, Chile, bozauc@med.puc.cl.
Camilo
C
Boza
Patricio
P
Valderas
David A
DA
Daroch
Felipe I
FI
León
José P
JP
Salinas
Diego A
DA
Barros
Ricardo A
RA
Funke
Fernando J
FJ
Crovari
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology* / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss