Clinical efficiency of metabolic surgery on type 2 diabetes mellitus patients with body mass index 27.5–32.5 kg/m<sup>2</sup>_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

JI Guangnian , ZHU Liyong , LI Pengzhou , YANG Xiangwu , LI Weizheng , SUN Xulong , QIU Xianjie , LI Rao ,  ZHU Shaihong

The Third Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha 410013, P. R. China;

Corresponding?author：

ZHU Shaihong, Email: shzhu@mail.csu.edu.cn

Keywords：

metabolic surgery; type 2 diabetes mellitus; mild obesity

DOI：

10.7507/1007-9424.201712102

Video：

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Objective To investigate effect of metabolic surgery on type 2 diabetes mellitus (T2DM) patients with body mass index (BMI) 27.5–32.5 kg/m². Methods The clinical data of 43 T2DM patients with BMI 27.5–32.5 kg/m² underwent metabolic surgery from October 2014 to October 2016 in the Third Xiangya Hospital of Central South University were analyzed retrospectively. The related indexes such as BMI, blood glucose level, blood lipid level were analyzed before and after metabolic surgery. Results All the patients underwent metabolic surgery successfully. Among them, 35 cases underwent laparoscopic gastric bypass surgery while 8 cases underwent laparoscopic sleeve gastrectomy without related complications after operation. Compared with preoperative indexes, the BMI, fasting blood glucose, HbA1c, triglyceride, and total cholesterol on the postoperative different time were all significantly decreased (P<0.05) except for the HbA1c on the postoperative 1-week, the high density lipoprotein level on the postoperative 12-month was significantly increased (P<0.05). The OGTT 30, 60, and 120 min blood glucose levels on the postoperative 1-week and 3-month, and 60 and 120 min blood glucose levels on the postoperative 6-month and 12-month were all significantly decreased (P<0.05). The OGTT-IRT 60 min insulin level on the postoperative 3-month and the 30 min insulin levels on the postoperative 6- and 12-month were all significantly increased (P<0.05). The levels of OGTT-CRT 30 and 60 min C peptide on the postoperative 6-month and the level of 30 min C peptide on the postoperative 12-month were all significantly increased (P<0.05). Conclusions Metabolic surgery is effective in treatment of T2DM patients with BMI 27.5–32.5 kg/m², and levels of blood glucose and blood lipids can be improved significantly. Synthesis and release of insulin by islet cells can be ameliorated.

Citation： JI Guangnian, ZHU Liyong, LI Pengzhou, YANG Xiangwu, LI Weizheng, SUN Xulong, QIU Xianjie, LI Rao, ZHU Shaihong. Clinical efficiency of metabolic surgery on type 2 diabetes mellitus patients with body mass index 27.5–32.5 kg/m². CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(3): 271-275. doi: 10.7507/1007-9424.201712102 Copy

1.	中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會. 中國肥胖和 2 型糖尿病外科治療指南(2014). 中國實用外科雜志, 2014, 34(11): 1005-1010.
2.	中華醫學會外科學分會內分泌外科學組, 中華醫學會外科學分會胃腸外科學組, 中華醫學會外科學分會外科手術學學組, 等. 中國糖尿病外科治療專家指導意見(2010). 中國實用外科雜志, 2011, 31(1): 54-58.
3.	Arterburn D, Schauer DP, Wise RE, et al. Change in predicted 10-year cardiovascular risk following laparoscopic Roux-en-Y gastric bypass surgery. Obes Surg, 2009, 19(2): 184-189.
4.	鄭成竹, 鄒大進, 丁丹. 2 型糖尿病外科治療標準化臨床路徑——2 型糖尿病內外科診療流程. 中國實用外科雜志, 2013, 33(1): 17-18.
5.	朱利勇, 李鵬洲, 趙磊, 等. 腹腔鏡 Roux-en-Y 胃旁路術治療 2 型糖尿病的療效及指標相關性分析. 中華肥胖與代謝病電子雜志, 2015, 1(2): 67-71.
6.	周玉龍, 韓曉東, 狄建忠, 等. Roux-en-Y 胃旁路術治療 2 型糖尿病的研究進展. 中國普外基礎與臨床雜志, 2014, 21(2): 246-250.
7.	李瀅旭, 方登華, 劉天錫. 3D 高清腹腔鏡在減重代謝手術中的應用. 中國普外基礎與臨床雜志, 2017, 24(9): 1106-1111.
8.	Dixon JB, Zimmet P, Alberti KG, et al. Bariatric surgery: an IDF statement for obese type 2 diabetes. Arq Bras Endocrinol Metabol, 2011, 55(6): 367-382.
9.	Dixon JB, Hur KY, Lee WJ, et al. Gastric bypass in type 2 diabetes with BMI <30: weight and weight loss have a major influence on outcomes. Diabet Med, 2013, 30(4): e127-e134.
10.	程中, 杜瀟. 2 型糖尿病外科治療術式合理選擇及評價. 中國實用外科雜志, 2014, 34(11): 1030-1032.
11.	Zhu L, Mo Z, Yang X, et al. Effect of laparoscopic Roux-en-Y gastroenterostomy with BMI<35 kg/m² in type 2 diabetes mellitus. Obes Surg, 2012, 22(10): 1562-1567.
12.	Wang G, Zhu L, Li W, et al. Can low BMI Chinese patients with type 2 diabetes benefit from laparoscopic Roux-en-Y gastric bypass surgery? Surg Obes Relat Dis, 2016, 12(10): 1890-1895.
13.	Espinosa O, Pineda O, Maydón HG, et al. Type 2 diabetes mellitus outcomes after laparoscopic gastric bypass in patients with BMI <35 kg/m ² using strict remission criteria: early outcomes of a prospective study among Mexicans. Surg Endosc, 2018, 32(3): 1353-1359.
14.	Horwitz D, Saunders JK, Ude-Welcome A, et al. Three-year follow-up comparing metabolic surgery versus medical weight management in patients with type 2 diabetes and BMI 30-35. The role of sRAGE biomarker as predictor of satisfactory outcomes. Surg Obes Relat Dis, 2016, 12(7): 1337-1341.
15.	Lee EY, Hwang S, Lee SH, et al. Postprandial C-peptide to glucose ratio as a predictor of β-cell function and its usefulness for staged management of type 2 diabetes. J Diabetes Investig, 2014, 5(5): 517-524.
16.	Caiazzo R, Zerrweck C, Verhaeghe R, et al. Gastric bypass and glucose metabolism. Diabetes Metab, 2009, 35(6 Pt 2): 528-531.
17.	Zerrweck C, Zurita L, álvarez G, et al. Taste and olfactory changes following laparoscopic gastric bypass and sleeve gastrectomy. Obes Surg, 2016, 26(6): 1296-1302.
18.	Chakravartty S, Tassinari D, Salerno A, et al. What is the mechanism behind weight loss maintenance with gastric bypass? Curr Obes Rep, 2015, 4(2): 262-268.
19.	Papamargaritis D, Miras AD, le Roux CW. Influence of diabetes surgery on gut hormones and incretins. Nutr Hosp, 2013, 28 Suppl 2: 95-103.

1. 中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會. 中國肥胖和 2 型糖尿病外科治療指南(2014). 中國實用外科雜志, 2014, 34(11): 1005-1010.
2. 中華醫學會外科學分會內分泌外科學組, 中華醫學會外科學分會胃腸外科學組, 中華醫學會外科學分會外科手術學學組, 等. 中國糖尿病外科治療專家指導意見(2010). 中國實用外科雜志, 2011, 31(1): 54-58.
3. Arterburn D, Schauer DP, Wise RE, et al. Change in predicted 10-year cardiovascular risk following laparoscopic Roux-en-Y gastric bypass surgery. Obes Surg, 2009, 19(2): 184-189.
4. 鄭成竹, 鄒大進, 丁丹. 2 型糖尿病外科治療標準化臨床路徑——2 型糖尿病內外科診療流程. 中國實用外科雜志, 2013, 33(1): 17-18.
5. 朱利勇, 李鵬洲, 趙磊, 等. 腹腔鏡 Roux-en-Y 胃旁路術治療 2 型糖尿病的療效及指標相關性分析. 中華肥胖與代謝病電子雜志, 2015, 1(2): 67-71.
6. 周玉龍, 韓曉東, 狄建忠, 等. Roux-en-Y 胃旁路術治療 2 型糖尿病的研究進展. 中國普外基礎與臨床雜志, 2014, 21(2): 246-250.
7. 李瀅旭, 方登華, 劉天錫. 3D 高清腹腔鏡在減重代謝手術中的應用. 中國普外基礎與臨床雜志, 2017, 24(9): 1106-1111.
8. Dixon JB, Zimmet P, Alberti KG, et al. Bariatric surgery: an IDF statement for obese type 2 diabetes. Arq Bras Endocrinol Metabol, 2011, 55(6): 367-382.
9. Dixon JB, Hur KY, Lee WJ, et al. Gastric bypass in type 2 diabetes with BMI <30: weight and weight loss have a major influence on outcomes. Diabet Med, 2013, 30(4): e127-e134.
10. 程中, 杜瀟. 2 型糖尿病外科治療術式合理選擇及評價. 中國實用外科雜志, 2014, 34(11): 1030-1032.
11. Zhu L, Mo Z, Yang X, et al. Effect of laparoscopic Roux-en-Y gastroenterostomy with BMI<35 kg/m² in type 2 diabetes mellitus. Obes Surg, 2012, 22(10): 1562-1567.
12. Wang G, Zhu L, Li W, et al. Can low BMI Chinese patients with type 2 diabetes benefit from laparoscopic Roux-en-Y gastric bypass surgery? Surg Obes Relat Dis, 2016, 12(10): 1890-1895.
13. Espinosa O, Pineda O, Maydón HG, et al. Type 2 diabetes mellitus outcomes after laparoscopic gastric bypass in patients with BMI <35 kg/m ² using strict remission criteria: early outcomes of a prospective study among Mexicans. Surg Endosc, 2018, 32(3): 1353-1359.
14. Horwitz D, Saunders JK, Ude-Welcome A, et al. Three-year follow-up comparing metabolic surgery versus medical weight management in patients with type 2 diabetes and BMI 30-35. The role of sRAGE biomarker as predictor of satisfactory outcomes. Surg Obes Relat Dis, 2016, 12(7): 1337-1341.
15. Lee EY, Hwang S, Lee SH, et al. Postprandial C-peptide to glucose ratio as a predictor of β-cell function and its usefulness for staged management of type 2 diabetes. J Diabetes Investig, 2014, 5(5): 517-524.
16. Caiazzo R, Zerrweck C, Verhaeghe R, et al. Gastric bypass and glucose metabolism. Diabetes Metab, 2009, 35(6 Pt 2): 528-531.
17. Zerrweck C, Zurita L, álvarez G, et al. Taste and olfactory changes following laparoscopic gastric bypass and sleeve gastrectomy. Obes Surg, 2016, 26(6): 1296-1302.
18. Chakravartty S, Tassinari D, Salerno A, et al. What is the mechanism behind weight loss maintenance with gastric bypass? Curr Obes Rep, 2015, 4(2): 262-268.
19. Papamargaritis D, Miras AD, le Roux CW. Influence of diabetes surgery on gut hormones and incretins. Nutr Hosp, 2013, 28 Suppl 2: 95-103.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical efficiency of metabolic surgery on type 2 diabetes mellitus patients with body mass index 27.5–32.5 kg/m²

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical efficiency of metabolic surgery on type 2 diabetes mellitus patients with body mass index 27.5–32.5 kg/m2

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Clinical efficiency of metabolic surgery on type 2 diabetes mellitus patients with body mass index 27.5–32.5 kg/m²