Effects of Gastric Bypass Surgery in Patients With Type 2 Diabetes and Only Mild Obesity
Contribuinte(s) |
UNIVERSIDADE DE SÃO PAULO |
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Data(s) |
24/10/2013
24/10/2013
2012
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Resumo |
OBJECTIVE-Roux-en-Y gastric bypass (RYGB) ameliorates type 2 diabetes in severely obese patients through mechanisms beyond just weight loss, and it may benefit less obese diabetic patients. We determined the long-term impact of RYGB on patients with diabetes and only class 1 obesity. RESEARCH DESIGN AND METHODS-Sixty-six consecutively selected diabetic patients with BMI 30-35 kg/m(2) underwent RYGB in a tertiary-care hospital and were prospectively studied for up to 6 years (median 5 years [range 1-6]), with 100% follow-up. Main outcome measures were safety and the percentage of patients experiencing diabetes remission (HbA(1c) <6.5% without diabetes medication). RESULTS-Participants had severe, longstanding diabetes, with disease duration 12.5 +/- 7.4 years and HbA(1c) 9.7 +/- 1.5%, despite insulin and/or oral diabetes medication usage in everyone. For up to 6 years following RYGB, durable diabetes remission occurred in 88% of cases, with glycemic improvement in 11%. Mean HbA(1c) fell from 9.7 +/- 1.5 to 5.9 +/- 0.1% (P < 0.001), despite diabetes medication cessation in the majority. Weight loss failed to correlate with several measures of improved glucose homeostasis, consistent with weight-independent antidiabetes mechanisms of RYGB. C-peptide responses to glucose increased substantially, suggesting improved beta-cell function. There was no mortality, major surgical morbidity, or excessive weight loss. Hypertension and dyslipidemia also improved, yielding 50-84% reductions in predicted 10-year cardiovascular disease risks of fatal and nonfatal coronary heart disease and stroke. CONCLUSIONS-This is the largest, longest-term study examining RYGB for diabetic patients without severe obesity. RYGB safely and effectively ameliorated diabetes and associated comorbidities, reducing cardiovascular risk, in patients with a BMI of only 30-35 kg/m(2). Municipal Health Authority, Marcia Maria Braido Hospital, Sao Paulo, Brazil Municipal Health Authority, Marcia Maria Braido Hospital, Sao Paulo, Brazil [22/02] Covidien Covidien Ethicon EndoSurgery Ethicon Endo-Surgery |
Identificador |
DIABETES CARE, ALEXANDRIA, v. 35, n. 7, supl. 1, Part 1, pp. 1420-1428, JUL, 2012 0149-5992 http://www.producao.usp.br/handle/BDPI/35862 10.2337/dc11-2289 |
Idioma(s) |
eng |
Publicador |
AMER DIABETES ASSOC ALEXANDRIA |
Relação |
DIABETES CARE |
Direitos |
closedAccess Copyright AMER DIABETES ASSOC |
Palavras-Chave | #BODY-MASS INDEX #BARIATRIC SURGERY #GASTROINTESTINAL SURGERY #LESS-THAN-35 KG/M(2) #METABOLIC SURGERY #WEIGHT-LOSS #LIFE-STYLE #MELLITUS #METAANALYSIS #BMI #ENDOCRINOLOGY & METABOLISM |
Tipo |
article original article publishedVersion |