Predictors of Remission of T2DM and Metabolic Effects after Laparoscopic Roux-en-y Gastric Bypass in Obese Indian Diabetics-a 5-Year Study.
BACKGROUND
Bariatric surgery has proven results for diabetes remission in obese diabetics. Despite this, a lot of ambiguity exists around patient selection. The objectives of this study are the following: (1) evaluation of results of laparoscopic Roux-en-y gastric bypass (LRYGB) in obese type 2 diabetic (T2DM) Indian patients at 5 years and (2) to define predictors of success after surgery.


METHODS
This is a prospective observational study. One hundred six Indian patients underwent LRYGB from January 2004 to July 2009. Patients were evaluated for percent excess weight loss (%EWL) and remission of T2DM. Mean age 50.34 ± 9.08 years, mean waist circumference 129.8 ± 20.8 cm, mean weight 119.2 ± 23.6 kg, mean BMI 45.01 ± 7.9 kg/m(2), and mean duration of diabetes 8.2 ± 6.2 years.


RESULTS
At 5 years, mean EWL% was 61.4 ± 20.3, mean weight regain of 8.6 ± 6.2 kg was seen in 63.6 %, mean glycosylated hemoglobin dropped from 8.7 ± 2.1 to 6.2 ± 01.3 %, mean triglycerides declined by 31 %, and serum high density lipoprotein rose by 18.4 %. Mean low-density lipoprotein levels declined by 6.8 %. Age, BMI, fasting C-peptide levels, duration of T2DM, and pre-op use of insulin emerged as significant predictors of success after surgery. One hundred percent remission was seen in patients with T2DM <5 years.


CONCLUSIONS
LRYGB is safe and efficacious for long-term remission of T2DM (BMI ≥ 35 kg/m(2)). In a country with the second largest population of type 2 diabetics in the world, predictors of success after surgery can help in prioritizing patients who have a greater chance to benefit from metabolic surgery.
Center for Obesity and Digestive Surgery, Mumbai, India, aparna@codsindia.com.
Aparna Govil
AG
Bhasker
Carlyne
C
Remedios
Payal
P
Batra
Amit
A
Sood
Shehla
S
Shaikh
Muffazal
M
Lakdawala
D000328:Adult; D002096:C-Peptide / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007194:India; D010535:Laparoscopy / Q000379:methods; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference / Q000502:physiology; D015431:Weight Loss / Q000502:physiology*
D002096:C-Peptide; D006442:Glycated Hemoglobin; D008077:Lipoproteins, LDL; D014280:Triglycerides