title: Impact of gastrointestinal bypass on nonmorbidly obese type 2 diabetes mellitus patients after gastrectomy.
abstract: BACKGROUND
  Our objective was to investigate the predictive preoperative factors and surgical components for type 2 diabetes mellitus (T2D) improvement in patients with body mass index (BMI) <35 kg/m(2).
  
  
  METHODS
  All patients undergoing curative surgical resection for gastric cancer involving Billroth I gastroduodenal anastomosis, Billroth II gastrojejunal anastomosis (B-I, B-II), or Roux-en-Y total gastrectomy (RYTG), from 2008-2011, were retrospectively reviewed. Of these, 90 patients with T2D were analyzed. The study population was divided into the "improved" and "not improved" groups. The preoperative and postoperative data were assessed using multiple logistic regression analysis. To assess the necessary surgical elements, the gastrointestinal reconstruction methods were categorized according to the presence of the fundus and gastrointestinal bypass.
  
  
  RESULTS
  Fifty-four patients (60%) experienced improvements in their T2D 2 years after surgery. Lower preoperative glycated hemoglobin (A1C) (odds ratio [OR]: .502; 95% confidence interval [CI]: .313-.804; P = .004), not using multiple oral antidiabetic medications (OR: .341; 95% CI: .120-.969; P = .043), and high BMI before surgery (OR: 1.294; 95% CI: 1.074-1.559; P = .007) were identified as independent predictors of T2D improvements. RYTG was more effective at improving T2D than B-I (OR: .160; 95% CI: .032-.794; P = .025). Statistical analysis according to the surgical elements showed that the bypass procedure was associated with T2D improvements (OR: 3.023; 95% CI: .989-9·240; P = .052).
  
  
  CONCLUSIONS
  Gastrointestinal bypass significantly contributes to T2D improvements in patients with BMI <35 kg/m(2). Low A1C, high BMI, and not using multiple antidiabetic medications were important predictors of T2D improvement.
authors: Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea.
authors: Jun
authors: J
authors: Pak
authors: Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea.
authors: Yeongkeun
authors: Y
authors: Kwon
authors: Bariatric and Metabolic Institute, Section of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, Florida.
authors: Emanuele
authors: E
authors: Lo Menzo
authors: Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea. Electronic address: kugspss@korea.ac.kr.
authors: Sungsoo
authors: S
authors: Park
authors: Bariatric and Metabolic Institute, Section of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, Florida.
authors: Samuel
authors: S
authors: Szomstein
authors: Bariatric and Metabolic Institute, Section of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, Florida.
authors: Raul J
authors: RJ
authors: Rosenthal
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D005763:Gastroenterostomy / Q000379:methods*; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications / Q000601:surgery*; D012074:Remission Induction; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: BMI; Bariatric surgery; Gastrectomy; Predictor; Type 2 DM