title: Effect of Roux-en-Y gastric bypass on the remission of type 2 diabetes: a 3-year study in Chinese patients with a BMI <30 kg/m2.
abstract: BACKGROUND
  Roux-en-Y gastric bypass (RYGB) is an effective treatment for patients with type 2 diabetes (T2D) and morbid obesity. However, T2D remission after surgery has not been adequately studied in Chinese patients with a body mass index (BMI)<30 kg/m2.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the 3-year effect of RYGB among patients with T2D with a BMI<30 kg/m2and elucidate the predictors of T2D remission.
  
  
  METHODS
  Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
  
  
  METHODS
  Sixty-six Chinese patients with T2D and a BMI 25-30 kg/m2were retrospectively examined for metabolic outcomes 3 years after RYGB. Remission was defined as glycated hemoglobin (HbA1C)<6.5% and no medications. Binary logistic regression analysis was used to identify preoperative parameters independently predictive of diabetes remission at 1 and 3 years postoperatively [variables: sex, age, BMI, T2D duration, plasma glucose 2 hours after meal, HbA1C, fasting C-peptide, visceral fat area, free triiodothyronine, and thyroid-stimulating hormone. There was no significant difference in fasting insulin or glucose between the remission and no remission groups.
  
  
  RESULTS
  Patients were a mean 50.4±11.4 years of age at baseline, and 57.6% were female. Mean T2D duration was 8.9±5.2 years, baseline HbA1C level was 8.3±1.9%, and baseline BMI was 28.2±1.2 kg/m2(range: 25.5-30.0). BMI was 22.5±1.8 kg/m2(range: 19.1-28.0) at 1 year and 23.0±1.76 kg/m2(range: 19.7-28.0) at 3 years. Remission was achieved in 49 patients (74.2%) at 1 year and 38 patients (57.6%) at 3 years. There was a significant reduction in medication for diabetes, hypertension, and hyperlipidemia (P<.01). Compared with patients in the no remission group, patients in the remission group had higher fasting C-peptide levels (P<.01) and free triiodothyronine levels (P = .01) at 1 year. Multiple logistic regression analysis confirmed that fasting C-peptide (odds ratio = 3.795, P = .007) and free triiodothyronine (odds ratio = 4.661, P = .019) levels were predictors of T2D remission at 1 year. No significant difference was found between the 2 groups at 3 years.
  
  
  CONCLUSIONS
  RYGB resulted in significant clinical and biochemical improvements in Chinese patients with BMI 25-30 kg/m2and T2D. Appropriate patient selection (better β-cell function) may produce better outcomes.
authors.affiliation: Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Jianzhong
authors.initials: J
authors.lastname: Di
authors.affiliation: Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Hongwei
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China.
authors.forename: Haoyong
authors.initials: H
authors.lastname: Yu
authors.affiliation: Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Pin
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. Electronic address: wangzgvip@126.com.
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China.
authors.forename: Weiping
authors.initials: W
authors.lastname: Jia
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002096:C-Peptide / Q000378:metabolism; D002681:China / Q000208:ethnology; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000473:pathology / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D050417:Insulin-Secreting Cells / Q000502:physiology; D050152:Intra-Abdominal Fat / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000208:ethnology / Q000473:pathology / Q000601:surgery; D012074:Remission Induction; D012189:Retrospective Studies; D013972:Thyrotropin / Q000378:metabolism; D016896:Treatment Outcome; D014284:Triiodothyronine / Q000378:metabolism
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin; D013972:Thyrotropin; D014284:Triiodothyronine
keywords: Overweight; Remission; Roux-en-Y gastric bypass; Type 2 diabetes (T2D); β-cell function