Impact of techniques for gastrointestinal tract reconstruction following gastrectomy on pancreatic β-cell function in patients with type 2 diabetes mellitus / 中华胃肠外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the impact of different techniques for gastrointestinal tract reconstruction on postoperative pancreatic β-cell function in patients with type 2 diabetes mellitus (T2DM).</p><p><b>METHODS</b>Twenty-three patients with gastric cancer and T2DM were studied. Techniques for reconstruction included Billroth I (n=13) and bypass procedures(Billroth II n=4 and Roux-en-Y anastomosis n=6). Pancreatic β-cell function was evaluated by oral glucose tolerance test (OGTT). Serum insulin was measured by electrochemiluminescence immunoassay and blood glucose by glucose oxidase method. HOMA-IR and HOMA-β were assessed.</p><p><b>RESULTS</b>T2DM remission rate was 90% (9/10) in the bypass group, and 23% (3/13) in Billroth I group (P<0.01). Glycosylated hemoglobin A1c and glycated hemoglobin HbA1 were improved significantly in patients after bypass procedures(P<0.05), but the difference in Billroth I group was not statistically significant (P>0.05). OGTT showed that fasting and post-glucose load plasma glucose at each time point were significantly lower in the bypass group compared to the Billroth I group. At 30 minutes and 60 minutes after glucose load, insulin levels and insulin release index were significantly higher in the bypass group compared to Billroth I( group, as were levels of HOMA-β and &Delta;I30/&Delta;G30 in the bypass group(P<0.05).</p><p><b>CONCLUSION</b>Gastrointestinal bypass following gastrectomy may induce resolution of T2DM and improve β-cells function.</p>