Metabolic Surgery: Roux-en-Y Gastric Bypass and Variables Associated with Diabetes Remission in Patients with BMI <35

Abstract

Metabolic results of bariatric surgery have determined an expansion of its traditional indications, being increasingly performed in non-severely obese patients, especially in type 2 diabetes mellitus (T2DM). Our aim is to determine the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) in T2DM remission in patients with body mass index (BMI) below 35kg/m(2) and the variables associated with T2DM remission after surgery. Retrospective analysis of diabetic patients with BMI <35kg/m(2) who underwent LRYGB in our center between 2002 and 2010 was done. We analyzed patient's demographics, comorbidities, BMI, excess weight loss percentage (EWLp), complications, and metabolic results at 3years. Univariate and multivariate analyses were performed to determine variables associated with T2DM remission. One hundred patients were included. Sixty patients (60%) were women; median age was 48years old (interquartile range (IQR) 42-54), and median preoperative BMI was 32.7kg/m(2) (IQR 31.6-34.1). Median preoperative duration of T2DM was 4years (IQR 2-7), with 49, 30, 2, and 18% on treatment with one, two, and three hypoglycemic agents and insulin, respectively. Ninety-four percent achieved 36-month follow-up, and at this time, median EWLp was 93% (IQR 67-121). A total of 53.2, 9.6, 25.5, and 11.7% achieved a T2DM complete remission, partial remission, improvement, and no improvement, respectively. T2DM remission only was associated with non-insulin use in multivariate analysis, with an OR = 15.1 (2.8-81.2) and p = 0.002. LRYGB is a reliable and effective treatment in diabetic patients with a BMI <35kg/m(2) at 3years. T2DM remission's best results are observed in non-insulin diabetic patients.