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Effect of Laparoscopic Roux-En Y Gastric Bypass on Type 2 Diabetes Mellitus

Schauer, Philip R MD*; Burguera, Bartolome MD; Ikramuddin, Sayeed MD; Cottam, Dan MD*; Gourash, William CRNP*; Hamad, Giselle MD*; Eid, George M. MD*; Mattar, Samer MD*; Ramanathan, Ramesh MD*; Barinas-Mitchel, Emma PhD§; Harsha Rao, R. MD; Kuller, Lewis MD DrPH§; Kelley, David MD

doi: 10.1097/01.sla.0000089851.41115.1b
Original Papers and Discussions

Objective: To evaluate pre- and postoperative clinical parameters associated with improvement of diabetes up to 4 years after laparoscopic Roux-en-Y gastric bypass (LRYGBP) in patients with type 2 diabetes mellitus (T2DM).

Summary Background Data: The surgical treatment of morbid obesity leads to dramatic improvement in the comorbidity status of most patients with T2DM. However, little is known concerning what preoperative clinical factors are associated with postoperative long-term improvement in diabetes in the morbidly obese patient with diabetes.

Methods: We evaluated pre- and postoperative data, including demographics, duration of diabetes, metabolic parameters, and clinical outcomes, in all patients with impaired fasting glucose (IFG) and type T2DM undergoing LRYGBP from July 1997 to May 2002.

Results: During this 5-year period, 1160 patients underwent LRYGBP and 240 (21%) had IFG or T2DM. Follow up was possible in 191 of 240 patients (80%). There were 144 females (75%) with a mean preoperative age of 48 years (range, 26–67 years). After surgery, weight and body mass index decreased from 308 lbs and 50.1 kg/m2 to 211 lbs and 34 kg/m2 for a mean weight loss of 97 lbs and mean excess weight loss of 60%. Fasting plasma glucose and glycosylated hemoglobin concentrations returned to normal levels (83%) or markedly improved (17%) in all patients. A significant reduction in use of oral antidiabetic agents (80%) and insulin (79%) followed surgical treatment. Patients with the shortest duration (<5 years), the mildest form of T2DM (diet controlled), and the greatest weight loss after surgery were most likely to achieve complete resolution of T2DM.

Conclusion: LRYGBP resulted in significant weight loss (60% percent of excess body weight loss) and resolution (83%) of T2DM. Patients with the shortest duration and mildest form of T2DM had a higher rate of T2DM resolution after surgery, suggesting that early surgical intervention is warranted to increase the likelihood of rendering patients euglycemic.

In patients with type 2 diabetes (T2DM), laparoscopic Roux-en-Y gastric bypass resulted in 60% percent of excess body weight loss and 83% resolution of diabetes. Patients with T2DM < 5 years and mild disease had a much higher rate of resolution after surgery (95% and 97%, respectively) than patients with T2DM >10 years or severe disease (54% and 62%, respectively).

From the Departments of **Surgery, ††Endocrinology, and §§Epidemiology, University of Pittsburgh, Pittsburgh, PA; and ‡‡Department of Surgery, University of Minnesota, Minneapolis, MN.

Presented at the annual meeting of The American Surgical Society, Thursday, April 24, 2003, Washington DC.

Reprints: Philip R. Schauer, MD, Director of Bariatric Surgery, The University of Pittsburgh, Magee-Women's Hospital, Suite 5500, 300 Halket Street, Pittsburgh, PA. E-mail: schauerpr@msx.upmc.edu; Website: www.upmc.edu/obesitysurgery.

© 2003 Lippincott Williams & Wilkins, Inc.