The foregut theory as a possible mechanism of action for the remission of type 2 diabetes in low body mass index patients undergoing subtotal gastrectomy for gastric cancer.

Abstract

BACKGROUND:

The question of whether pure metabolic surgery could be used in nonobese patients with type 2 diabetes has been considered. The objective of this study was to assess the comparative effects of the Billroth I (BI) and Billroth II (BII) reconstruction methods on remission of type 2 diabetes in nonobese patients undergoing subtotal gastrectomy for cancer.

METHODS:

The charts of 404 patients who underwent radical subtotal gastrectomy for cancer between January 2008 and December 2010 were retrospectively reviewed. From these patients, 49 with type 2 diabetes were included in this study. Diabetes remission rates, the percentage change in fasting plasma glucose levels, glycated hemoglobin levels, body mass index, and fasting total cholesterol levels at 2 years were observed. Outcomes were compared using propensity scores and inverse probability-weighting adjustment that reduced treatment-selection bias. Covariate-adjusted logistic regression models were assessed.

RESULTS:

The 2-year diabetes remission rate for the 23 patients who underwent BI reconstruction was 39.1%, compared with 50.0% for the 26 patients who underwent BII reconstruction. At 2 years, the BII group showed lower glycated hemoglobin levels (BI, 6.4%; BII, 6.1%; P = .003) and had greater percent reductions in their average glycated hemoglobin levels from baseline (BI,-11.6%; BII,-14.5%; P = .043). BII reconstruction was significantly associated with an increased diabetes remission rate (odds ratio, 3.22; 95% confidence interval, 1.05-9.83) in covariate-adjusted logistic regression analysis.

CONCLUSIONS:

These propensity score-adjusted analyses of patients who had undergone subtotal gastrectomy indicated that BII reconstruction was associated with increased diabetes remission compared with BI reconstruction during the 2-year follow-up period. This study suggests the possibility of employing the surgical duodenal switch for the treatment of nonobese type 2 diabetes patients.

• Authors: Yeongkeun Kwon, Abraham Abdemur, Emanuele Lo Menzo, Sungsoo Park, Samuel Szomstein, Raul J Rosenthal
• Journal: Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Surg Obes Relat Dis) 2014 Mar-Apr Vol. 10 Issue 2 Pg. 235-42 ISSN: 1878-7533 [Electronic] United States
• PMID: 24496047 (Publication Type: Comparative Study, Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 American Society for Bariatric Surgery Published by American Society for Metabolic and Bariatric Surgery All rights reserved.

Chemical References

• Blood Glucose
• Glycated Hemoglobin A

Topics

• Aged
• Blood Glucose (metabolism)
• Body Mass Index
• Diabetes Mellitus, Type 2 (blood, complications)
• Female
• Follow-Up Studies
• Gastrectomy (methods)
• Glycated Hemoglobin (metabolism)
• Humans
• Male
• Middle Aged
• Propensity Score
• Remission Induction
• Retrospective Studies
• Stomach Neoplasms (blood, complications, surgery)
• Time Factors
• Treatment Outcome