Application value of laparoscopic Roux-en-Y gastric bypass in treating nonobese type 2 diabetes mellitus

Abstract

Objective To investigate the application value of laparoscopic Roux-en-Y gastric bypass (LRYGB) in treating nonobese type 2 diabetes mellitus, and analyze the clinical indexes which influence operative effect. Methods Clinical data of 32 patients with nonobese type 2 diabetes mellitus undergoing LRYGB in the Department of Gastrointestinal Surgery in the People’s Hospital of Lishui between June 2011 and June 2014 were retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients were divided into complete remission group, partial remission group and invalid group according to postoperaive hypoglycemic effect. Among the 12 patients of complete remission group, 6 were males and 6 were females with an average age of (50±10) years old. Among the 19 patients of partial remission group, 9 were males and 10 were females with an average age of (51±7) years old. One male patient was in invalid group with the age of 64 years old. Waist circumference, weight, body mass index (BMI), fasting plasma glucose (FPG), 2-hour postprandial blood glucose (2hPG), glycosylated hemoglobin A1c, C-peptide, insulin, triglyceride, total cholesterol, homeostatic model assessment of insulin resistance (HOMA-IR) and homeostatic model assessment of β-cell function (HOMA-β) of all the patients were recorded before and 3, 6 and 12 months after surgery. Clinical indexes before and after surgery, and between complete remission group and partial complete remission group were compared using t test. Results At 12 months after surgery, 12 patients got complete remission and 19 patients got partial remission of type 2 diabetes, and the total effective rate was 96.9%. The duration of type 2 diabetes and waist circumference in the complete remission group patients before surgery was (5±3) years and (87±7) cm respectively, which were significantly shorter than (8±4) years and (92±8) cm of the partial remission group (t=2.54, 2.23, P<0.05); FPG and 2hPG of the complete remission group patients before surgery were (7.0±1.6) mmol/L and (11.9±3.8) mmol/L respectively, which were significantly lower than (11.4±3.3) mmol/L and (19.0±5.7) mmol/L of the partial remission group (t=4.96, 3.82, P<0.05); 2-hour postprandial C-peptide (2hCp), 2-hour postprandial insulin (2hIns) and HOMA-β of the complete remission group patients before surgery were (3.0±1.0) ug/L, (59±42) mU/L and 66±22, which were significantly higher than (2.4±0.8) ug/L, (26±12) mU/L and 35±20 of the partial remission group(t=2.19, 3.27, 4.10, P<0.05); HOMA-IR of the complete remission group patients before surgery was 3.6±2.3, which was significantly lower than 5.8±2.2 of the partial remission group (t=2.70, P<0.05). Conclusions LRYGB has a good curative effect on nonobese type 2 diabetes; the patients with shorter duration of disease, smaller waist circumferences, lower FPG and 2hPG, higher 2hCp and 2hIns, lower HOMA-IR and higher HOMA-β usually can achieve better curative effects, and these 8 indexes may become the predictors of curative effect of LRYGB on nonobese type 2 diabetes. Key words: Laparoscopic Roux-en-Y gastric bypass; Diabetes mellitus, type 2; Treatment outcome