Effects of gastric bypass on non-obese type 2 diabetes mellitus / 中华内分泌外科杂志

ABSTRACT

Objective To observe therapeutical effects of gastric bypass on non-obese type 2 diabetes patients.Methods From June 2008 to April 2010,data of 47 patients with both gastric lesions and non-obese type 2 diabetes mellitus undergoing gastric bypass in the Institute of General Surgery were studied.The patients were divided into 3 groups according to the operation typetotal stomach resection plus Roux-en-Y anastomosis ( n =20),partial stomach resection plus Roux-en-Y anastomosis(n =13)and Billroth Ⅱ gastrectomy(n =14).They were followed for 6 months after surgery.Level of body mass index (BMI),fasting blood glucose (FBG) and GLP-1 was measured before operation and on the 1 st week,2nd week,1 st month,3rd month,and 6th month after operation.The level of glycosylated hemoglobin was measured before operation and on the 3rd and 6th month after operation.The prognosis of the patients on the 6th month after surgery was evaluated.Results Compared with preoperative level,FBG level in all the 3 groups significantly decreased on the 1 st week after surgery and maintained a similar level during the follow-up period (P ＜ 0.01 ).GLP-1 level was elevated after operation (P ＜0.01 or P ＜ 0.05).On the 3rd and 6th month after operation,glycosylated hemoglobin level in all the 3 groups significantly decreased (P ＜ 0.01 or P ＜ 0.05 ).The change of the above parameters was greater in groups undergoing Roux-en-Y anastomosis than in Billroth Ⅱ group(P ＜ 0.05 ).The control rate of T2DM for Billroth Ⅱ,partial stomach resection plus Roux-en-Y anastomosis and total stomach resection plus Roux-en-Y anastomosis was 78.5％(11/14),100％ (13/13) and 100％ (20/20)respectively on the 6th month after surgery,indicating Roux-en-Y gastric bypass had better effect of blood glucose control than Billroth Ⅱ (P ＜ 0.05 ).Postoperative BMI decreased significantly in all groups (P ＜ 0.05) and there was no statistical difference between all the groups (P ＞ 0.05 ).Conclusions All groups of gastric bypass are effective in terms of glucose control.Roux-en-Y gastric bypass is more effective than Billroth Ⅱ on diabetes control and its therapeutic effect is independent of weight loss.