Gastric bypass procedure for the type 2 diabetes patients with BMI < 28 kg/m2

Ke Gong, Nengwei Zhang, Bin Zhu, Dexiao Du, Dongdong Zhang, Zhen Zhang, Jirun Peng. Beijing Shijitan Hospital, Capital Medical University, Beijing, China.

Objectives To evaluate the Gastric bypass(GBP) procedure for the patients who suffered from type 2 diabetes (T2DM) with BMI<28 kg/m2.

Methods Thirty-one suffering from T2DM were selected to undergo GBP surgery were enrolled at Beijing Shijitan Hospital, Capital Medical University between November 2012 to September 2014. The fasting plasma glucose(FPG), glycosylated hemoglobin(HbA1c),C-peptide, fasting insulin(FINS) and glucagon-like peptide-1(GLP-1) of all patients were measured before and at 1, 6 months after surgery. The results were analyzed.

Results 31 patients suffered from T2DM underwent GBP surgery successfully ( a mean age of 46 years), 14 were male and 17 were female, Among them, 7 patients had hypertriglyceridemia (HTG). The patients were followed up for 6 months. No major complications. The average body mass index (BMI) was 26.5±1.7 kg/m2 before surgery and 21.9±2.4 kg/m2 at 6 month after surgery, which was statistically decreased at 6 months after surgery compared with that before surgery (P<0.05). The average levels of FPG, HbA1c, C-peptide, FINS of all patients were statistically decreased at 1,6 months after surgery respectively compared to those before surgery (all P<0.05). However, the mean GLP-1 of all patients was (2.6±2.5 pmol/L ) before surgery, and was (3.9±1.7pmol/L, 4.8±1.8 pmol/L) at 1,6 months  after surgery respectively, the mean GLP-1 of all patients were statistically increased after surgery compared to those before surgery  (all P<0.05). At 6 months after surgery, 22 patients (71.0%) achieved complete remission of T2DM with HbA1c<6.5%, and stopped taking diabetic medications, 7 patients (22.6%) gained partial remission of T2DM with 6.5%≤HbA1c<7.0%, and 2 patients(6.5%) 3.84% got no remission of T2DM. The mean serum triglyceridein of 7 patients with HTG was decreased statistically at 6 months after surgery compared to that before surgery (3.04±3.71mmol/L vs 1.45±1.08 mmol/L).

Conclusions This research shows that GBP procedure is safe and effective for the patients who suffered from T2DM with BMI <28 kg/m2 , and the patients with hypertriglyceridemia were greatly improved. Moreover, the further studies with larger samples and long term follow-up are needed.