Roux-en-Y gastric bypass stands the test of time: 5-year results in low body mass index (30-35 kg/m(2)) Indian patients with type 2 diabetes mellitus

Lilavati Hospital and Research Center, Mumbai, India.
Surgery for Obesity and Related Diseases (Impact Factor: 4.07). 08/2012; 9(3). DOI: 10.1016/j.soard.2012.07.017
Source: PubMed


Our objective was to evaluate the long-term results of laparoscopic Roux-en-Y gastric bypass on excess weight loss, remission of the metabolic syndrome, and complications in Indian patients with uncontrolled type 2 diabetes mellitus (T2DM) with a body mass index of 30-35 kg/m(2). The setting was a corporate hospital in Mumbai, India.

The present prospective observational study was begun in January 2006. A total of 52 patients with uncontrolled T2DM and a body mass index of 30-35 kg/m(2) elected to undergo laparoscopic Roux-en-Y gastric bypass. The duration of T2DM was 3.5-14.5 years (median 8.4). Of the 52 patients, 61.5% had hypertension and 59.6% had dyslipidemia. Remission of T2DM and other components of the metabolic syndrome were assessed. All patients were followed up for 5 years.

The median percentage of excess weight loss was 72.2% at 1 year and 67.8% at 5 years. Of the 52 patients, 84.6% had achieved euglycemia and 73.1% had achieved complete remission, 23.1% partial remission, and 3.84% no remission at 1 year. Weight regain occurred in 8 patients. They required antihypertensive drugs and statins, decreasing the complete remission rate to 57.7% and partial remission rate to 38.5% at 5 years. However, 96.2% improvement in metabolic status was found at the end of 5 years.

Laparoscopic Roux-en-Y gastric bypass is a safe, efficacious, and cost-effective treatment for uncontrolled T2DM in patients with a body mass index of 30-35 kg/m(2). Early-onset T2DM, better weight loss, and greater C-peptide levels were predictors of success after surgery. The improvement after surgery in hyperglycemia, hypertension, and dyslipidemia could help in controlling the occurrence of micro- and macrovascular complications and decrease the morbidity and mortality associated with T2DM.

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    • "ma glucose ( FPG ) <110 mg / dl and HbA1c <6% ) , even with a markedly improved insulin resistance , after a follow - up of 2 years ( Lee et al . , 2011b ) . Similar results were obtained in Indian patients with class I obesity and , after 5 years of follow - up , diabetes remission according to ASA criteria was maintained in 57 . 7% of patients ( Lakdawala et al . , 2013 ) . BPD in 30 diabetic patients with mild obesity or simply overweight showed slightly better results and diabetes remission ( defined as HbA1c <6% ) was obtained in 67% ( Scopinaro et al . , 2011 ) ."

    02/2015, Degree: PhD, Supervisor: Francisco Castro e Sousa
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    • "Consideration should be given to the possibility of a worsening in diabetes remission rates over time. According to the 5‐year results among Indian patients with type 2 diabetes and a low BMI (30–35 kg/m2)22, 84.6% of the patients had achieved euglycemia (defined as A1c <7.0%) without medication at the end of 1 year. No hyperglycemia recurred in any of the patients showing remission, despite regaining weight. "
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    ABSTRACT: Aims/IntroductionLittle is known about the long-term effects of Roux-en-Y gastric bypass (RYGB) in severely obese Asian individuals.Methods and MaterialsA total of 33 severely obese patients with type 2 diabetes underwent RYGB. All patients were followed up for 2 years. Visceral and abdominal subcutaneous fat areas were assessed using computed tomography (CT) before, and 12 and 24 months after RYGB. The muscle attenuation (MA) of paraspinous muscles observed by CT were used as indices of intramuscular fat.ResultsThe mean percentage weight loss was 22.2 ± 5.3% at 12 months, and 21.3 ± 5.1% at 24 months after surgery. Compared with the baseline values, the visceral fat area was 53.6 ± 17.1% lower 24 months after surgery, and the abdominal subcutaneous fat area was 32.7 ± 16.1% lower 24 months after surgery. The MA increased from 48.7 ± 10.0 at baseline to 52.2 ± 8.9 (P = 0.009) 12 months after surgery. The MA after the first 12 months maintained changes until 24 months. Triglycerides and free fatty acids were reduced after surgery, whereas the high-density lipoprotein cholesterol levels were increased significantly after surgery. At the last follow-up visit, 18 patients (55%) had diabetes remission. The percentage of iron and vitamin D deficiency was 30% and 52%, respectively.Conclusions We found that patients subjected to RYGB had significant sustained reductions in visceral and intramuscular fat. There were durable improvements in the cardiometabolic abnormalities without any significant comorbidities. However, there were mild nutritional deficiencies in these patients despite daily supplementation with multivitamins and minerals.
    03/2014; 5(2). DOI:10.1111/jdi.12137

  • 07/2012; 2(2):75-6. DOI:10.4103/2229-516X.106346
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