The Effect Of Subtotal Gastrectomy On Type 2 Diabetes Mellitus In Non-Obese Patients

BACKGROUND AND AIMSThe number of Diabetes mellitus, especially Diabetes mellitus type 2, is increasing sharply. Current therapies, including diet, exercise, diabetic medication, and insulin, can control PG and reduce the incidence of the complication, but the morbidity and mortality are increasing year by year because of poor compliance. Retrospective analysis of bulk Case of bariatric surgery in last century suggests that the upper gastrointestinal surgery produce significant and durable weight loss and the most intriguing effect of it is rapid and dramatic control of the comorbidity of massive obesity: type 2 diabetes. The aim of this study is to investigate whether subtotal gastrectomy can represent an effective therapy for type 2 diabetes and prediabetes in nonobese patients, and try to explain the mechanisms.METHODSThe documents of the patients who had been admitted into the department of General Surgery of Qilu Hospital, and undergone subtotal gastrectomy in the period of January 2001 to May 2007 were reviewed. If the patient was concurrent with type 2 diabetes or prediabetes and BMI≤30, the blood glucose after the 5th postoperative day and 3rd month were respectively compared with their own preoperative parameter, and the dosage of hypoglycemic medication and the way of anastomosis were analyzed. Analysis of variance for repeated measures, two-Sample Paired t-test, x~2 Test and Fisher's exact probabilities in 2*2 table were used to analyze the effect of anastomosis on improvement of glucose metabolism. P < 0.05 was considered statistically significant.RESULTSSixty-one patients' cases were analyzed. The mean of their Body Mass Index (BMI) is 24.25±3.06 (SD). In the type 2 diabetes patients without application of diabetic medication or remedial insulin, The mean plasma glucose level after the 5th postoperative day and 3rd month are respectively lower than that before operation. And the most patients with application of hypoglycemic medication reduced dosage to control blood glucose after subtotal gastrectomy. Moreover, the effects of different anastomosises on improving glucose metabolism are different.CONCLUSIONSsubtotal gastrectomy has a significant effect on type 2 diabetes in nonobese patients. Its effect is independent and not secondary to the glucose level before operation. In addition, the effect of duodenal exclusion is better on improving glucose metabolism.