Abstract
to evaluate the effectiveness of Roux-en-Y gastric bypass in improving the glycemic profile of obese patients with type 2 Diabetes Mellitus (DM2) after 18 months of follow-up. four hundred sixty-eight pacients with DM2 and BMI ≥35 were submitted to Roux-en-Y gastric bypass, from 1998 to 2010. All patients were submitted to glycemic control analysis in the 3rd, 6th, 9th, 12th and 18th postoperative months. We considered: type 2 diabetic patients, the ones with fasting glucose ≥126mg/dl and HbA1C ≥6.5 in two dosages; high risk patients for diabetes, those who presented fasting glucose ≥ 100 to 125 mg/dl and HbA1C between 5.7%-6.4%; and normal patients, those presenting glucose <100mg/dl and HbA1C <5.7%. Such diagnostic criteria were based on the official position of Sociedade Brasileira de Diabetes, published in July, 2011. The remission of DM2 was seen in 410 (87.6%) out of 468 patients 18 months after the surgery, that being a meaningful difference, with p<0.001. Fourty-eight (10.3%) patients sustained criteria for the disease and ten (2.1%) continued at high risk for DM2. Roux-en-Y gastric bypass was effective in the promotion and maintaince of long-term glycemic control. There are evidences showing that the remission of DM2 is not only related to weight loss and that other enteroinsular axis mechanisms must be involved. avaliar a eficácia da gastroplastia com derivação em Y-de-Roux, em pacientes obesos e portadores de Diabetes Mellitus tipo 2 (DM2), na melhoria do perfil glicêmico após 18 meses de seguimento. foram submetidos à derivação gástrica em Y-de-Roux 468 pacientes com IMC ≥35 e portadores de DM2, no período de 1998 a 2010. Todos os pacientes tiveram a análise do controle glicêmico realizadas no terceiro, sexto, nono, 12o e 18o meses de pós-operatório. Os critérios diagnósticos de diabetes foram baseados no Posicionamento Oficial da Sociedade Brasileira de Diabetes, publicado em julho de 2011. observou-se a remissão do DM2 em 410 pacientes (87,6%) após 18 meses da cirurgia, sendo essa diferença significativa com p-valor <0,001. A doença se manteve inalterada em 48 pacientes (10,3%), e dez pacientes (2,1%) permaneceram com o risco aumentado para DM2. a gastroplastia com derivação em Y-de-Roux foi efetiva na promoção e manutenção do controle glicêmico em longo prazo.
Highlights
Obesity is a serious problem of public health worldwide, affecting developed and developing countries
The aim of this study is to evaluate the effectiveness of Roux‐en‐Y gastric bypass (RYGB) in improving glycemic control in obese patients with BMI ≥ 35 who meet the criteria for Diabetes Mellitus tipo 2 (DM2)
The main mechanisms for the remission of DM2 after RYGB are restricted caloric intake, reduction of ghrelin, which stimulates the reduction of appetite, intestinal malabsorption, weight loss, with reduction of visceral fat, reducing insulin resistance, increased metabolic rate, and especially modulation of gastrointestinal hormones, the incretins[8,9,10,11,12,13,14,15]
Summary
Obesity is a serious problem of public health worldwide, affecting developed and developing countries. Obesity is an independent risk factor for the development of various associated diseases such as type-2 diabetes mellitus (DM2), hypertension (HT), dyslipidemia, metabolic syndrome (MS), hepatic steatosis, gastroesophageal reflux disease, cholelithiasis, among others[2]. Diabetes mellitus is the most common metabolic disease in Western countries, with an estimated 300 million people affected in 2025, of which 90% will be carriers of DM2. Diabetes is a major cause of mortality and early disability. An increasing body of evidence suggests that most of the complications of diabetes can be prevented or delayed by prospective treatment of hyperglycemia. The timing and quality of therapy, consequences of early diagnosis and immediate continued control of hyperglycemia, are crucial to improving outcomes[4]
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