Laparoscopic Roux-en-Y gastric bypass for excess weight and diabetes: a multicenter retrospective cohort study in China

Wah Yang,Cunchuan Wang,Ding Ding,Shuqing Yu,Shaihong Zhu,Jason R Waggoner,Tengfei Yang,Elliott J Fegelman,Zhong Cheng,Jingge Yang,Michael L Schwiers,Yi Chen,Nengwei Zhang,Liangping Wu

doi:10.20517/2574-1225.2021.06

Abstract

Aim: The aims of this study were to better understand the outcomes of Roux-en-Y gastric bypass (RYGB) surgery in patients across multiple hospitals in China along with patients with type 2 diabetes mellitus (T2DM) and to explore the potential preoperative predictors of diabetes outcomes after RYGB. Methods: This was a retrospective cohort study in Chinese patients who underwent laparoscopic RYGB at five Chinese hospitals from April 2009 to December 2014 and returned for follow-up approximately one-year post-surgery. The STROCSS guideline checklist was applied. Results: In total, 130 patients underwent RYGB: 85 males and 45 females; age, 43.4 ± 11.3 years; and preoperative body mass index (BMI), 33.1 ± 9.0 kg/m2. Of those, 103 (79.2%) had T2DM duration of 6.6 ± 4.7 years and pre-RYGB HbA1c of 8.1 ± 1.9%. Among the patients with T2DM, glycemic control (HbA1c < 7.0%) increased from 28.7% before surgery to 79.3% at 12 months post-procedure, with a concurrent reduction in the use of anti-hyperglycemic agents, including a reduction in insulin requirement from 55.4% to 27.0%. The percentage of excess weight loss was -42.8 ± 44.2%. Among 71 patients with T2DM and data about remission status, 14 (19.7%) achieved T2DM remission at 12 months post-surgery. Age and duration of T2DM were lower in the remission group, while baseline BMI and weight were higher compared with the non-remission group. Conclusion: RYGB may be effective for weight loss and T2DM control in Chinese patients, and outcomes are consistent with the literature in Western populations. Younger patients with T2DM and with a higher BMI pre-surgery and shorter duration of T2DM were more likely to achieve T2DM remission.

Highlights

Age and duration of type 2 diabetes mellitus (T2DM) were lower in the remission group, while baseline body mass index (BMI) and weight were higher compared with the non-remission group
Roux-en-Y gastric bypass (RYGB) may be effective for weight loss and T2DM control in Chinese patients, and outcomes are consistent with the literature in Western populations
World Health Organization (WHO) estimates that 422 million adults globally were living with type 2 diabetes mellitus (T2DM) in 2014 and that the prevalence of T2DM has doubled since 1980[1]

Summary

Introduction

World Health Organization (WHO) estimates that 422 million adults globally were living with type 2 diabetes mellitus (T2DM) in 2014 and that the prevalence of T2DM has doubled since 1980[1]. China has almost 115 million patients with T2DM, with an adult diabetes prevalence of 9.8% that is rapidly increasing, presenting in individuals with higher insulin resistance but with lower body mass index (BMI) and approximately 10 years younger than their Western counterparts[2,3,4]. Bariatric metabolic surgeries such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy have emerged as the most effective interventions for sustained weight and diabetes control in patients who are obese[11]. Given the burden of disease in China, metabolic surgery is being undertaken in some patients at even lower BMI[12,13]. Studies showed that laparoscopic RYGB could be beneficial in patients with BMI < 28 kg/m2, or even < 27.5 kg/m2[12,13]

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