A Clinical Study Of One Year Effect For Modified Roux-en-Y Gastric Bypass In The Treatment Of Non-obese Type2Diabetes Mellitus: One Year Follow-up

Backgrounds and objective:Diabetes Mellitus (DM) is currently one of the chronic diseases seriouslyworsening humans’ health. Type2diabetes mellitus (T2DM) is accounting fornearly90%～95%among DM patients and its incidence increases year by yeareven at a prevalent trend. At present, the main treatments include diet therapy,exercise, oral hypoglycemic agents and insulin, but the effect is limited, notcuring DM fundamentally and not preventing serious complications and thedevelopment of the disease. Though there are a number of reports about thegood effect for Roux-en-Y gastric bypass (RYGP) on obese T2DM patients,there is not enough evidence supporting that RYGP can attain equivalentoutcomes in non-obese T2DM patients with BMI below30kg/m~2. The main aim of this study is to evaluate the one year effect and its factors of modified RYGPin the treatment of non-obese T2DM and investigate the reasonable indicationsfor surgery through clinical case-control study on modified RYGP in thetreatment of non-obese T2DM.Methods:72patients diagnosed as T2DM by modified RYGP in our department fromMay2009to June2010were included in this study, the follow-up data includedfasting plasma glucose (FPG),2h plasma glucose after oral glucose challenge(2hPG), weight, BMI (Body Mass Index) and medication usage in1month,3months,6months and1year postoperative; hemoglobin A1c (HbA1c), fastingC-peptide (C-P), fasting serum insulin (Fins) and Homeostasis ModelAssessment of Insulin Resistance index (HOMA-IR) in6months and1yearpostoperative, respectively. The statistical analysis was performed by SPSS17.0software.Otherwise, after balancing many indicators preoperative,60patients weredivided into two groups by preoperative history of T2DM: Ⅰgroup: less thanfive years; Ⅱ group: five to ten years,BMI of both groups were below30kg/m~2.The follow-up data including FPG,2hPG, weight, BMI, HbA1c, C-P, Fins,HOMA-IR and medication usage in6months and1year postoperative wereobserved and analyzed. Control analysis before and after the procedure andcomparative analysis between the two groups were performed by SPSS17.0software.Results:⒈Compared with the preoperative, FPG,2hPG, weight and BMI in onemonth, three months, six months and one year after surgery were markedly improved (P<0.05); HbA1c, C-P and HOMA-IR in six months and one yearafter surgery were markedly improved (P<0.05) and there was no significantdifference in Fins (P>0.05). The rates of complete remission in one month, threemonths, six months and one year after surgery were gradually improved(P<0.05),22.2%,27.%,36.1%and60.6%, respectively, and the rate ofremission in one year was94.3%. The complete remission of one year aftersurgery was associated with normal C-P and insulin antibody (-)(P<0.05).⒉Compared with the preoperative data, FPG,2hPG, weight, BMI, C-P,HbA1c and Fins of Ⅰ group were markedly improved (P<0.05), HOMA-IR ofthe six months after surgery was of no significant difference (P>0.05), whereas,there was significant difference in HOMA-IR of the one year after surgery(P<0.05). In the Ⅱ group, FPG,2hPG, weight, BMI, C-P, HbA1c and HOMA-IRwere markedly improved compared with the preoperative (P<0.05), Fins of thesix months and one year were of no significant difference (P>0.05). There wereno difference in six months and one year postoperative in FPG,2hPG, weight,BMI, C-P, Fins, HbA1c, HOMA-IR, use of medications and rates of remissionof operation between Ⅰ groupand Ⅱ group(P>0.05).⒊Compared with normal fasting C-P preoperative, abnormally decreasedC-P significantly increases the risk of elevating of FPG one year after modifiedRYGP（Odds ratio, OR:6.625, Confidence interval of95%:1.307～33.585）.Conclusions:⒈Modified RYGP was performed in the treatment of non-obese type2diabetes patients safely and effectively, the function of islet cells wassignificantly improved, especially for the patients of which islet cells functionwas normal, BMI was below25kg/m~2and fasting plasma glucose was7-10mmol/L before surgery, the rate of complete remission after one year was the best.⒉The glucose metabolism of one year after modified RYGP were markedlyimproved in non-obese T2DM patients, the rates of complete remission afteroperation were gradually increased and the influence of preoperative T2DMhistory (≤5years and5-10years) on the one year effect was of no significantlydifference.⒊Fasting normal C-P was a protective factor for good control of FPG oneyear after modified RYGP.