title: Laparoscopic Roux-en-Y gastric bypass for nonobese type II diabetes mellitus in Asian patients.
abstract: BACKGROUND
  The beneficial role of laparoscopic Roux-en-Y gastric bypass (LRYGB) for type 2 diabetes mellitus (T2 DM) in morbidly obese patients has been established; however, there is scant evidence supporting its effectiveness in nonobese T2 DM Asian patients. The objective of this study was to evaluate the effect of LRYGB in nonobese T2 DM patients and elucidate the predictors of DM remission after one year follow-up.
  
  
  METHODS
  Between June 2009 and May 2011, twenty-nine nonobese (body mass index (BMI)<27 kg/m(2)) Asian patients with T2 DM who underwent LRYGB were enrolled. All patients were prospectively followed up for one year. Baseline demographic characteristics, diabetic status, and clinical and biochemical data were collected preoperatively and one year after LRYGB. DM remission was defined as those with hemoglobin A1 c (HbA1 c)<6.5% without oral hypoglycemic drugs (OHA)/insulin. Outcomes in the DM remission group were compared with the nonremission group and analyzed.
  
  
  RESULTS
  All clinical and biochemical parameters, except uric acid, were significantly improved. DM remission was achieved in eleven patients (37.9%) of whom five (45.5%) were male. Blood glucose, HbA1 c, c-peptide, homeostatic model assessment (HOMA-%B), and low density lipoprotein (LDL)-cholesterol were the significant variables in patients with DM remission; however, multiple logistic regression showed that only preoperative HOMA-%B (odds ratio (OR) = 1.13, 95% CI = 1.03-1.24) was a predictor for DM remission. Though no mortality was seen, the complication rate was 20.7%, of which 17.3% was related to marginal ulcers.
  
  
  CONCLUSIONS
  LRYGB resulted in significant clinical and biochemical improvements in nonobese Asian patients, with HOMA-%B indicating β-cell function as the main predictor of T2 DM remission. Appropriate patient selection with better β-cell function and evidence from long-term follow-up may justify this therapeutic approach.
authors.affiliation: Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Kaohsiung City, 82445, Taiwan.
authors.forename: Kirubakaran
authors.initials: K
authors.lastname: Malapan
authors.affiliation: Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Kaohsiung City, 82445, Taiwan.
authors.forename: Rajat
authors.initials: R
authors.lastname: Goel
authors.affiliation: Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Kaohsiung City, 82445, Taiwan; Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chi-Ming
authors.initials: CM
authors.lastname: Tai
authors.affiliation: Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Kaohsiung City, 82445, Taiwan.
authors.forename: Yu-Hsi
authors.initials: YH
authors.lastname: Kao
authors.affiliation: Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Kaohsiung City, 82445, Taiwan.
authors.forename: Po-Chih
authors.initials: PC
authors.lastname: Chang
authors.affiliation: Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Kaohsiung City, 82445, Taiwan. Electronic address: dr.ckhuang@hotmail.com.
authors.forename: Chih-Kun
authors.initials: CK
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D008076:Cholesterol, HDL / Q000378:metabolism; D008078:Cholesterol, LDL / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013624:Taiwan / Q000208:ethnology; D016896:Treatment Outcome; D014280:Triglycerides / Q000378:metabolism; D055105:Waist Circumference
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D014280:Triglycerides
keywords: Asian; LRYGB; Metabolic surgery; Nonobese; Type 2 diabetes mellitus