| Diabetic mellitus is a common incretion disease, characterized by hyperglycemia, lipid disorders and glucose metabolic disorder. T2DM mainly caused by relatively absence of insulin and insulin resistance, characterized by carbohydrates, fats, protein, vitamins, water and electrolyte metabolism disorder and so on. The incidence of diabetes is increasing year by year around the world. it is reported that the world prevalence of diabetes among adults will be 6.4%, affecting 285 million adults, in 2010. According to the WHO’s survey,the number of diabetes patient is expected to double in 2030 and new cases are mainly concentrated in developing countries such as China. The Chinese Diabetes Society reported prevalence of diabetes of adults over the age of 20 was 9.7%,number of cases was more than 90 million and 90% of cases had T2DM.The traditional treatment of T2DM include health education, medical nutrition therapy, physical exercise, monitoring of diabetes mellitus, drug therapy, GLP-1 analogues and DPP IV inhibitors. With above strategies,most individuals can not achieve the desired therapeutic effect. The tight control of blood sugar closely correlation with the development of diabetic complications. Diabetes complications do great harm to body health. The harmfulness of diabetes is not high blood glucose itself,but because of diabetic complications,which threaten the human health. the acute complication of diabetes includes diabetic ketoacidosis and hyperosmolar hyperglycemic status. Hyperosmolar hyperglycemic status is that due to body not makeing enough of the hormone insulin, This increases blood pressure and blood sugar and then causes dehydration, leading to severe dehydration. Diabetic ketoacidosis is a life-threatening problem that affects people with diabetes. It occurs when the body cannot use sugar (glucose) as a fuel source because there is, no insulin or not enough insulin. Fat is used for fuel instead. If can not get reasonable treatment, diabetic ketoacidosis and hyperosmolar hyperglycemic status can lead to death. Before insulin was found,the mortality of diabetic ketoacidosis almost 100%.It indicated that Diabetic ketoacidosis is a major cause of death of youth with diabetes.The chronic complication of diabetes does most serious harm to human body and is the major cause of mortality and morbidity in patients with type 2 diabetes. Diabetes macroangiopathy can lead to coronary heart disease, cardiomyopathy, congestive heart failure, myocardial infarction, sudden death, ischemic or hemorrhagic cerebrovascular disease, brain atrophy, cerebral arteriosclerosis, renal artery sclerosis, hardening of the arteries of the body. Diabetic microangiopathy is the specific complications of diabetes and its typical changes is microcirculation disturbance and the walls of the vessels become abnormally thick,which can lead to diabetic retinopathy and diabetic nephropathy. After geting diabetes more than 20 years,100% of people with type 1 diabetes and 60% of patients with type 2 diabetes may appear different degree of retinopathy. Diabetic retinopathy is the leading causes of blindness in adults in the United States. Patients with diabetic nephropathy will shorten their life and affect the way of life and work. Diabetic nephropathy is a major cause of progress for advanced kidney disease in most countries and is also an important cause of death. When diabetic nephropathy has progressed to an advanced stage, patients need dialysis or a kidney transplant. it has added to country and patients’ financial burden. Diabetic neuropathy can affect any parts of body and can raise paresthesia, pain, insensitive, feeling disappear, nervous reflex, muscle paralysis, muscle atrophy, pupil change, delayed gastric emptying, diarrhea, constipation, light reflex disappearing, abnormal sweating, orthostatic hypotension, tachycardia, cardiac distance extend continuously, the residual urine volume increased, urinary incontinence, urinary retention and sexual dysfunction. Diabetic foot is common diabetic chronic complications, associated with lower extremity neuropathy and peripheral vascular disease,and can lead to lower extremity ulcers, infections and (or) deep tissue injury.light patients show foot deformity and the skin is dry and cold,while severe patients foot ulcer and gangrene.It is said that about 15% of people with diabetes will occur foot ulcers or gangrene at some point during their lifetimes. The rate of amputation of patients with type 2 diabetes is more than 17 times as to nondiabetic patients. Diabetic foot is the main reason for the amputation and disability. Diabetes patients are prone to infection, and their infection rate is higher and more serious, treatment more difficult. Patients can often infect furuncle and carbuncle and contribute to the recurrence, refractoriness. Skin fungal infections such as athlete’s foot carbuncle also often can occur. Female patients can appear fungal vaginitis and Bartholin gland inflammation. Diabetic patients also can appear like mucormycosis, malignant otitis externa, emphysematous cholecystitis and emphysematous pyelonephri-tis. The incidence of diabetes patients with tuberculosis is 2.0～3.6 times higher than nondiabetic patients. Diabetes can also cause a variety of joint disease, skin lesions, and affect the healing of wounds. Diabetes is greatly threatening the health of human and social development. Diabetes has become one of serious global public health problem and brings a heavy burden on society and economy.Doctor Pories first reported obese patients with type 2 diabetes not only significantly reduced the weight, but diabetes also improved after gastric bypss in 1995. From then on, people for the treatment of type 2 diabetes saw new hope. Weight loss surgery in the treatment of type 2 diabetes have flourished. Due to bariatric surgery good therapeutic effect,bariatric surgery was recommended as one of the standard treatment of type 2 diabetes mellitus by experts and various guidelines. For the first time, the NIH guidelines recommended by the patient’s BMI as a standard of choose bariatric s surgery patients in 1991.It recommended Patients whose BMI exceeds 40 are potential candidates for surgery; patients with BMI’s between 35 and 40 also may be considered for surgery. Included in this category are patients with high-risk comorbid conditions such as life-threatening cardiopulmonary problems (e.g:severe sleep apnea, Pickwickian syndrome, and obesity-related cardiomyopathy) or severe diabetes mellitus. Other possible indications for patients with BMI’s between 35 and 40 include obesity-induced physical problems interfering with lifestyle (e.g., joint disease treatable but for the obesity, or body size problems precluding or severely interfering with employment, family function, and ambulation). Most clinical guidelines and statements have followed the BMI-based criteria established by 1991 National Institutes of Health Consensus Conference Guidelines. In 2009, ADA (American diabetes association) for the first time recommended bariatric surgery surgery can be used for the treatment of T2DM.It advise bariatric surgery should be considered for adults with BMI>35 kg/m2 and type 2 diabetes, especially if the diabetes is difficult to control with lifestyle and pharmacologic therapy. In 2011, the IDF (the international diabetes federation) issued a statement that bariatric surgery should be considered for a treatment for people with BMI>35 kg/m2; bariatric surgery be considered a reasonable therapeutic alternativefor low BMI (30kg/m2～35kg/m2) patients with T2DM who do not respond to standard medical therapy, especially with cardiovascular risk factors.In my country,two gaidline recommended:bariatric surgery should be considered for adults with BMI>35 kg/m2, no matter with or without complications of T2DM; bariatric surgery be considered a reasonable therapeutic alternative for BMI (30kg/m2-35 kg/m2) patients with T2DM who do not respond to standard medical therapy, especially with cardiovascular risk factors; bariatric surgery be considered a therapeutic alternative for BMI (30kg/m2-35 kg/m2) patients with T2DM who have central obesity (Waist> 85 cm in female, Waist> 90 cm in male) and also have two metabolic syndrome standard at least(High triglycerides, low HDL cholesterol, high blood pressure); For patients with BMI 25.0 kg/m2-27.9 kg/m2,surgery should be seen as experimental study, and should not be widely promoted.Anther guideline advise bariatric surgery be considered a reasonable therapeutic alternative for BMI>27.5 kg/m2 patients with T2DM who do not respond to standard medical therapy or can’t tolerate treatment; For patients with BMI<27.5 kg/m2,surgery should be seen as experimental study, and should not be widely promoted.Recently, China’s obesity and type 2 diabetes surgical treatment guidelines(2014) have released,and it suggest that:BMI>32.5 kg/m2 patients with T2DM should get active surgery; bariatric surgery be considered a reasonable therapeutic alternative for BMI 27.5 kg/m2-32.5 kg/m2 patients with T2DM who do not respond to standard medical therapy or at least conform to the presence of 2 components of metabolic syndrome or have additional complications; to BMI 27.5 kg/m2-32.5 kg/m2 patients with T2DM, surgery should be carried out carefully.The gastric bypass surgery as a representative of weight loss surgery has been widely applied in the treatment of type 2 diabetes, but choice of type 2 diabetes mellitus patients, especially in patients with BMI<35,remains controversial at present.We summarized ours clinical experience on laparoscopic gastric bypass surgery recent years. Compara and study Clinical effect of three groups of different BMI patients after the laparoscopic gastric bypass. To explore impact of BMI on the clinical efficacy of treatment of type 2 diabetes mellitus after the laparoscopic gastric bypass.ObjectiveTo explore the clinical efficacy of type 2 diabetes paitient with different BMI after the laparoscopic gastric bypass.Methods20 patients were randomly selected from type 2 diabetes mellitus patients with BMI of 25kg/m2～28kg/m2 after laparoscopic gastric bypass surgery in our hospital between 2010 to 2013,20 patients from type 2 diabetes mellitus patients with BMI of 28kg/m2～35kg/m2 and 20 patients from type 2 diabetes mellitus patients with BMI>35 kg/m2. Accordingly, the total of 60 patients were divided into low BMI group, middle BMI group and high BMI group. Three groups of patients had the same operation. Hemoglobin A1C<7% is defined as glucose control.We compares and analyses the difference the rate of blood glucose control, other indicators,such as body weight, waist circumference, hip circumference, BMI, fasting blood glucose, postprandial 2 hours blood sugar, fasting c-peptide, postprandial 2 hours C peptide, fasting insulin and insulin 2 hours after meal and the occurrence of operative and post-operative complications between three groups. The rate of blood glucose control between three groups are compared with chi-square test. Indicators between three groups are compared with One-Way ANONA. Indicators within three groups are compared with Paired Samples Test. The p value is less than 0.05 is considered statistically significant, with double side inspection. The data analysis with statistical software SPSS 13.0.Resultsthe rate of blood glucose control of low BMI group is 75%,middle BMI group 85%,and high BMI group 90%. there is no statistical difference of the rate of blood glucose control between three groups at 12 months after laparoscopic gastric bypass surgery, Body weight, BMI, waist circumference, hip circumference, fasting blood glucose, postprandial 2 hours blood sugar obviously improve in all patients,and fasting insulin and postprandial serum insulin decreased at 12 months after laparoscopic gastric bypass surgery, fasting c-peptide, postprandial 2 hours C peptide aslo decreased in high BMI group at 12 months after laparoscopic gastric bypass surgery. Each two patients has developed low blood glucose in middle BMI group and high BMI group. Each two patients had gastrointestinal anastomotic ulcer in three group.ConclusionType 2 diabetes paitient with 28.0 kg/m2-29.9 kg/m2 Could obtain the same treatment outcome,and type 2 diabetes paitient with 25.0 kg/m2-28.0 kg/m2 can also benefit from the surgery and achieve satisfactory clinical effect, also can be regarded as a kind of options of treatment method of type 2 diabetes mellitus.All the patient of type 2 diabetes mellitus with different BMI in three group can acquire satisfying clinical therapeutic effect after the laparoscopic gastric bypass. |
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