Gastrointestinal metabolic surgery for the treatment of diabetic patients: a multi-institutional international study.

Lee, Wei-Jei; Hur, Kyung Yul; Lakadawala, Muffazal; Kasama, Kazunori; Wong, Simon K H; Lee, Yi-Chih

BACKGROUND Gastrointestinal metabolic surgery has been proposed for the treatment of not well-controlled type 2 diabetes mellitus (T2DM) patients with a body mass index (BMI) <35 kg/m(2). This study aims to describe recent experience with surgical treatment of T2DM in Asian centers. METHODS Patients aged 20 to 70 years with not well-controlled T2DM [glycated hemoglobin (HbA1C) >7.0%] and BMI < 35 kg/m(2) were included at five institutes between 2007 and 2010. The end point is T2DM remission, defined by fasting plasma glucose <110 mg/dl and HbA1C <6.0%. RESULTS Of the 200 patients, 172 (86%) underwent gastric bypass, 24 (12%) underwent sleeve gastrectomy, and the other 4 underwent adjustable banding. Laparoscopic access was used in all the patients. Gender (66.5% female), age (mean 45.0 ± 10.8), and HbA1C (mean 9.3 ± 1.9%) did not differ between the procedure among the groups. Until now, 87 patients had 1-year data. One year after surgery, the mean BMI decreased from 28.5 ± 3.0 to 23.4 ± 2.3 kg/m(2) and HbA1C decreased to 6.3 ± 0.5%. Remission of T2DM was achieved in 72.4% of the patients. Patients with a diabetes duration of <5 years had a better diabetes remission rate than patients with duration of diabetes >5 years (90.3% vs. 57.1%; p = 0.006). Patients with BMI > 30 kg/m(2) had a better diabetes remission rate than those with BMI < 30 kg/m(2) (78.7% vs. 62.5%; p = 0.027). Individuals who underwent gastric bypass loss more weight and had a higher diabetes remission rate than individuals who underwent restrictive-type procedures. Multivariate analysis confirmed that the duration of diabetes and the type of surgery predict the diabetes remission. No mortalities were reported and two (1.0%) patients had major morbidities. CONCLUSION Gastrointestinal metabolic surgery is an effective treatment for not well-controlled T2DM treatment. Diabetes remission is significantly higher in those with duration of diabetes less than 5 years and BMI > 30 kg/m(2).