Factors influencing the effect of gastric bypass surgery on type-2 diabetes mellitus

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Objective To investigate the factors influencing the effect of gastric bypass surgery on type-2 diabetes mellitus.Methods The clinical data of 99 patients with type-2 diabetes mellitus who received gastric bypass surgery at the General Hospital of Chengdu Military Command from March 2009 to March 2010 were retrospectively analyzed.All the patients were followed up for 1 year.The results of oral glucose tolerance test (OGTr) and C-peptid release test were obtained,the levels of insulin and glycosylated hemoglobin (HbAlc) were dynamically monitored,and the insulin resistance indexes (HOMA-IR) and body mass indexes (BMI) were calculated.Complete clinical remission was defined as not requiring any hypoglycemic measures and capable of maintaining long-term random blood glucose levels ＜ 11.1 mmol/L,fasting blood glucose levels ＜ 7.0 mmol/L,2-hour blood glucose levels ＜ 11.1 mmol/L and HbAlc ＜ 6.5％; improved condition was defined as having a significant reduction in necessary drug administration or dietary modifcation to control normal blood glucose levels after surgery; any patient who did not meet these criteria was considered unaffected.All data were analyzed using the repeated measures design,one-way analysis of variance or LSD-t test.Results Of the 99 patients,79 patients (80％) met the criteria of complete remission,the conditions of 9 patients (9％) were improved,and the surgery was ineffective in 11 patients (11％).The preoperative body weight,BMI,fasting,30 minutes and 1-,2-,3-hour postprandial C-peptide,30 minutes and 1-hour postprandial glucose,30 minutes and 1-hour postprandial insulin were (75 ± 14)kg,(27 ±4) kg/m2,(2.1 ±0.8) nmol/L,(2.8 ± 1.2)nmol/L,(3.8 ± 1.7) nmol/L,(4.5 ± 2.2) nmol/L,(3.5 ± 1.2) nmol/L,(16 ± 3) mmol/L,(19 ± 4) mmol/L,(29 ± 21) U/L,(37 ± 27) U/Lfor patients with complete remission,(62 ± 10) kg,(24 ± 4) kg/m2,(1.3 ± 0.5) nmol/L,(1.8 ± 1.0) nmol/L,(1.9 ± 0.8) nmol/L,(2.8 ± 1.7) nmol/L,(2.7 ± 1.5) nmol/L,(17 ± 5) mmol/L,(20 ± 6) mmol/L,(18 ±13) U/L and (17 ± 12) U/L for patients with improved condition,and (71 ± 12) kg,(24 ± 3) kg/m2,(1.6 ±0.6)nmol/L,(2.2±0.9)nmol/L,(2.8 ±l.3)nmol/L,(2.8 ±l.0)nmol/L,(2.5 ±l.4)nmol/L,(17±5)mmol/L,(20 ± 4) mmol/L,(17 ± 10) U/L and (24 ± 16) U/L for patients who were unaffected,with significant differences between the 3 groups (F=3.989,5.328,5.860,4.315,7.504,5.208,4.512,3.341,8.154,3.456,3.514,P ＜0.05).Conclusion The body weight,BMI,fasting,30 minutes and 1-,2-,3-hour postprandial C-peptide,30 minutes and 1-hour postprandial glucose,30 minutes and 1-hour postprandial insulin are factors influencing the effect of gastric bypass surgery on type-2 diabetes mellitus. Key words: Diabetes mellitus, type 2; Gastric bypass surgery; Clinical effect; Pancreatic β-cell