Clinical Observation After Roux-en-Y Gastric Bypass In Type2Diabetes Mellitus

There are about150million people with diabetes worldwide at present., and more than90million people with diabetes in China with an upward trend. Traditional medicaltreatment can only control the blood sugar, but there is no way for its complications.Diabetes mellitus can not fundamentally ease. Gastric bypass surgery originated in bariatricsurgery in the mid-20th century,, Some surgeons found that obese patients with type2diabetes has a lower blood glucose levels after surgery, Mason, who verified the results,consider bariatric surgery on blood glucose and glucose tolerance improved significantlyeffect, which opens the door for the surgical treatment of diabetes. Currently gastric bypasssurgery has become a hot research, and the principle mechanism has been explained, andsurgical approach has also been improved. World Diabetes Federation, European Uniondiabetes, American Diabetes Association regard to gastric bypass surgery in its guidelines,and believes that it is one of the means to treat diabetes. China also writes it to "Chinesetype2diabetes prevention and treatment guidelines," and recommended it for earlyintervention. In this article, the effect of the surgery was judged by differences compared112cases of gastric various metabolic indicators to determine in type2diabetic patientsafter bypass surgery,and further analyzed the impact of those sensitive indicator to theresults.Objective To observe the change of multiple metabolic indexes within one year afterRoux-en-Y gastric bypass in the treatment of type2diabetes mellitus,and to probe theindication of operation and the choice of applicable people.Methods The clinical and laboratory data before and after surgery in112patients diagnosed as type2diabetes mellitus by RYGB was included in this study. According toBMI, the patients were divided into two groups: normal weight group (≤25kg/m2), and theoverweight obesity group (>25kg/m2). The follow-up (postoperative1，3,6,9,12months)data included physiologic and biochemical indices.The statistical analysis was performedby SPSS17.0software.Results1Four cases included early complications: the wound of one case whichoccurred in patients with incision fat liquefaction, delayed healing;2cases of gastroparesishad discharged through continued decompression and nutritional support. One patient withanastomotic obstruction had discharged after removed the obstruction. Postoperativecomplication rate was approximately4.5%.2HbA1c, FPG, P2hPG were significantlyreduced compared with the preoperative; HbA1c in two groups were statistically significantin6,12months after surgery (P<0.05);FPG in two groups were significantly reduced in1,3months after surgery. there were statistically significant in6,12months after surgery (P<0.05); P2hPG between the two groups showed no each month(P>0.05).3TG, TCHO,LDL-C of two groups decreased significantly after surgery.Overweight and obese groupsdecreased more rapidly.Lipids has in the two grops (P<0.05); LDL-C of normal weightgroup has significant difference in6months after surgery (P <0.05). HDL-C in two groupswere increased, but there was no statistical difference between groups (P>0.05). There is nosignificant difference in TG, TCHO, LDL-C in two groups (P>0.05).4Restructuringnormal after no significant changes in body weight, showed no significant difference (P>0.05) with preoperative; overweight and obese group0to3months after surgery weightloss is slow, there was no significant difference between preoperative (P>0.05), but weightdecreased significantly in3months after surgery compared with the preoperative and werestatistically significant (P<0.05).5Fins, CP, HOMA-IR in the two groups weresignificantly lower, HOMA-β rebounded; CP in overweight and obese group wasstatistically significant in6months after surgery compared with the preoperative (P<0.05);HOMA-β between the two groups shows significant differences after6,12months (P<0.05).6Principal component analysis found that postoperatively contribution of BMI andHbA1c in6months was bigger, and HOMA-β, HOMA-IR had larger contribution to the results in6months after surgery.7There is significant difference in the effect compared3～6months,6～12months,>12months with0～3months (P<0.05).8There is significantdifference in the effect between the two groups in6～12months and>12months aftersurgery.Conclusions Various metabolic indexes in patients with type2diabetes improvesignificantly within one year after surgery, and complete remission rate is graduallyincreased. Weight, blood glucose, serum lipids, HOMA–β and HOMA-IR get moresignificant improvements in overweight and obese group than in normal weight group.Obese patients are more appropriate for the surgical treatment. BMI, HbA1c，HOMA–βand HOMA-IR has great guiding significance in operation effectiveness evaluation andpreoperative indications.