Clinical Observation The Effect Of Laparoscopic Gastric Bypass On Type2Diabetic Patients With Metabolic2Syndrome And BMI28-35kg/m~2

ObjectiveTo investigate the effect of laparoscopic gastric bypass on type2diabeticpatients with metabolic syndrome and BMI28-35Kg/m2.MethodFrom July2010to March2011，42T2DM patients were recruited inDepartment of General Surgery in General Hospital of Armed Police Forces withBMI28-35kg/m2,stratified by metabolic syndrome into two groups：group1metabolic syndrome group (referred to as: MS group),group2non metabolicsyndrome group(referred to as: NMS group). Testing oral glucose tolerance test,insulin release test, C peptide release test, HbA1c, Triglycerides(TG),Cholesterol(CH), High density lipoprotein cholesterol(HDL-C), Low densitylipoprotein cholesterol(LDL-C), waist circumstance(WC),hip circumstance wereperformed GBP surgery preoperatively and then at1,3,6and12monthspostoperatively.Then the BMI, waist-to-hip ratio (WHR), homeostasis modelinsulin resistance index (HOMA-IR), HOMA-β, insulin sensitivity index (ISI),insulin action index (IAI), early-phase insulin secretion index (△Ins30/△G30), insulin secretion index (△Ins30/△G30)/IR, the glucose area under the curve (AUCg) and insulin area under the curve (AUCIns) were calculated.Results1. Weight change：BMI values of42patients were significantly decreasedduring the1-year follow-up after surgery(P=0.000in MS group,P=0.008inNMS group in1year after surgery).Between the two groups showed nosignificant differences(P=0.155).2. Improvement of glucose metabolism:The patient’s overall compliance ratewas77.5%in12months after surgery.The compliance rate of glucosemetabolism in the MS group was89.5%(17/19), The compliance rate ofglucose metabolism in the NMS group was66.7%(14/21).3. The pancreatic islet function changes:①In1year after surgery, bothgroups compared with preoperative fasting insulin (Fasting Insulin, FIns)values had overall downward trend. In MS group after six months the valuewas the lowest, the difference of Fins was statistically significant after1,6,12months(P=0.037,0.043,0.045). The NMS group there was no significantdifferences in postoperative points. Group were compared in FIns nosignificant difference.②In1year after surgery, both groups compared withpreoperative HOMA-IR values had overall downward trend. In MS group thedifference was statistically significant at all time points(P=0.004,0.025,0.007,0.006). In NMS group, each time after the point wasno significant difference, the difference was not statistically significant.HOMA-IR value of the two groups showed no significant difference.ConclusionLaparoscopic gastric bypass has remission effect on non-morbid obesityT2DM, and the resolution of T2DM after LBP is independent with weight loss.The metabolic disturbance may be one of the candidate criteria for T2DMon LBP beyond BMI.