title: Long-term effects of laparoscopic Roux-en-Y gastric bypass on diabetes mellitus, hypertension and dyslipidaemia in morbidly obese patients.
abstract: BACKGROUND
  Severely obese patients have an increased risk for developing metabolic complications such as type 2 diabetes mellitus (T2DM), dyslipidaemia (DL) and hypertension (HT). The aim of the present study is to research the effect of a primary laparoscopic Roux-en-Y gastric bypass (LRYGB) on T2DM, HT and DL in the long-term.
  
  
  METHODS
  Fifty-two out of 89 (58 %) adult severely obese patients with T2DM who had received a LRYGB between January 2000 and December 2008 were evaluated. Primary outcome of evaluation was remission of T2DM according to the definition of 2009 consensus statement. Complete remission was defined as achievement fasting plasma glucose (FPG) of <5.6 mmol/l (<100.8 mg/dL) and HbA1c <42 mmol/mol (<6.0 %)) without glucose-lowering medication for at least 1 year. Partial remission was defined as a FPG of 5.6-6.9 mmol/l (100.8-124.2 mg/dL) and HbA1c 42-48 mmol/mol (6.0-6.5 %), without glucose-lowering medication for at least 1 year. Remission of T2DM was considered if the patient met the criteria for complete or partial remission. Secondary outcomes were remission of HT, DL and changes in medication use.
  
  
  RESULTS
  Patients had a mean age of 47.5 ± 9.6 years, body mass index of 46.6 ± 6.4 kg/m(2) and a mean duration of T2DM of 6.1 ± 5.4 years at the time of surgery. The mean post-operative follow-up period was 6.9 ± 2.3 years. At the end of the follow-up, mean weight loss was 60 ± 24 % excess weight loss (EWL) and 26 ± 10 % total body weight loss (TBWL). Mean HbA1c level had significantly decreased from 64.8 ± 19.7 mmol/mol to 46.4 ± 12.9 mmol/l (p < 0.0001). Overall medication use was reduced from 85 % to 37 % of the patients (p < 0.0001), while the number of insulin users was reduced from 40 % to 6 % (p < 0.0001). Nineteen percent of the patients had a relapse of T2DM during follow-up. Pre-operative HbA1ac level (odds ratio 0.911, p = 0.020) and duration of T2DM (odds ratio 0.637, p = 0.010) were independent risk factors for failed remission of T2DM. The number of patients with HT was significantly reduced from 73 % to 54 % (p = 0.042), and number of patients with DL was non-significantly decreased from 71 % to 54 % (p = 0.068).
  
  
  CONCLUSIONS
  The laparoscopic RYGB operation results in a sustained EWL of 60 % (26 % TBWL) with 52 % long-term remission of T2DM. However, 19 % of the patients had a relapse of their T2DM. Furthermore, HT and DL improved markedly.
authors.affiliation: Department of Surgery, Rijnstate Hospital, Postal number 1190, P.O. Box 9555, 6800 TA, Arnhem, The Netherlands, dogan_kemal@hotmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Dogan
authors.forename: B
authors.initials: B
authors.lastname: Betzel
authors.forename: J
authors.initials: J
authors.lastname: Homan
authors.forename: E O
authors.initials: EO
authors.lastname: Aarts
authors.forename: N
authors.initials: N
authors.lastname: Ploeger
authors.forename: H
authors.initials: H
authors.lastname: de Boer
authors.forename: Th J
authors.initials: TJ
authors.lastname: Aufenacker
authors.forename: C J H M
authors.initials: CJ
authors.lastname: van Laarhoven
authors.forename: I M C
authors.initials: IM
authors.lastname: Janssen
authors.forename: F J
authors.initials: FJ
authors.lastname: Berends
mesh_terms: D000328:Adult; D001786:Blood Glucose; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D050171:Dyslipidemias / Q000150:complications; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000150:complications; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000150:complications / Q000601:surgery*; D011184:Postoperative Period; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin