title: The Development of Diabetes after Subtotal Gastrectomy with Billroth II Anastomosis for Peptic Ulcer Disease.
abstract: OBJECTIVE
  A duodenal bypass after a Roux-en-Y gastric bypass operation for obesity can ameliorate the development of diabetes mellitus (DM). We attempted to determine the subsequent risk of developing DM after subtotal gastrectomy with Billroth II anastomosis (SGBIIA) for peptic ulcer disease (PUD).
  
  
  METHODS
  We identified 662 patients undergoing SGBIIA for PUD between 2000 and 2011 from the Longitudinal Health Insurance Database as the study cohort, and we randomly selected 2647 controls from the peptic ulcer population not undergoing SGBIIA and were frequency-matched by age, sex, and index year for the control cohort. All patient cases in both cohorts were followed until the end of 2011 to measure the incidence of DM. We analyzed DM risk by using a Cox proportional hazards regression model.
  
  
  RESULTS
  The patients who underwent SGBIIA demonstrated a lower cumulative incidence of DM compared with the control cohort (log-rank test, P < .001 and 6.73 vs 12.6 per 1000 person-y). The difference in the DM risk between patients with and without SGBIIA increased gradually with the follow-up duration. Age and sex did not affect the subsequent risk of developing DM, according to the multivariable Cox regression model. Nevertheless, the SGBIIA cohort exhibited a lower DM risk after we adjusted for the comorbidities of hypertension, hyperlipidemia, and coronary artery disease (adjusted hazard ratio (aHR): 0.56, 95% confidence interval (CI): 0.40-0.78). The incidence rate ratio (IRR) of DM in the SGBIIA cohort was lower than that in the control cohort for all age groups (age ≤ 49 y, IRR: 0.40, 95% CI: 0.16-0.99; age 50-64 y, IRR: 0.54, 95% CI: 0.31-0.96; age ≧ 65 y, IRR: 0.57, 95% CI: 0.36-0.91). Moreover, the IRR of DM was significantly lower in the SGBIIA cohort with comorbidities (IRR: 0.50, 95% CI: 0.31-0.78) compared with those without a comorbidity (IRR: 0.65, 95% CI: 0.40-1.04).
  
  
  CONCLUSIONS
  The findings of this population-based cohort study revealed that SGBIIA was associated with a reduced risk of DM development, and the inverse association was greater in the presence of a comorbidity.
authors.affiliation: Digestive Disease Center, Show-Chwan Memorial Hospital, Changhua, Taiwan.|Hungkuang University, Taichung, Taiwan.|Chung Chou University of Science and Technology, Yuanlin Township, Changhua County, Taiwan.
authors.forename: Chien-Hua
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Digestive Disease Center, Show-Chwan Memorial Hospital, Changhua, Taiwan.
authors.forename: Che-Ming
authors.initials: CM
authors.lastname: Hsu
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.|College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Cheng-Li
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan.|School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: An-Kuo
authors.initials: AK
authors.lastname: Chou
authors.affiliation: Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.|Department of Surgery, Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Long-Bin
authors.initials: LB
authors.lastname: Jeng
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D005763:Gastroenterostomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications / Q000601:surgery*; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult