Roux-en-Y gastric bypass for nonobese patients with uncontrolled type 2 diabetes: a long-term evaluation

• Published in: Surgery for obesity and related diseases Vol. 15; no. 5; pp. 682 - 687
• Main Authors: Ferraz, Álvaro A.B., de Sá, Vladimir C.T., Santa-Cruz, Fernando, Siqueira, Luciana T., Silva, Lyz B., Campos, Josemberg M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2019
• Subjects: Adolescent; Adult; Aged; Blood Glucose - analysis; Body Mass Index; Brazil; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - surgery; Female; Gastric Bypass - methods; Humans; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; Male; Metabolic surgery; Middle Aged; Overweight; Prospective Studies; Remission Induction; Roux-en-Y gastric bypass; Type 2 Diabetes; Weight Loss; Brazil; Metabolic surgery; Roux-en-Y gastric bypass; Type 2 Diabetes; Overweight
• ISSN: 1550-7289; 1878-7533
• DOI: 10.1016/j.soard.2019.02.006

There is growing evidence that the impact of Roux-en-Y gastric bypass (RYGB) on type 2 diabetes (T2D) occurs regardless of the amount of weight loss. Taking this background into consideration, it is plausible to study this procedure in individuals with lower body mass index (BMI) under clinical treatment failure for uncontrolled T2D.
To elucidate the long-term impact of RYGB on T2D regression in a non-obese population.
Hospital das Clínicas, Federal University of Pernambuco, Brazil.
Twelve patients with BMI 25 to 30 kg/m2 and inadequately controlled T2D underwent RYGB and were followed up for 6 years. Fasting plasma glucose, glycated hemoglobin, BMI, and the use of insulin and/or oral hypoglycemic agents were assessed. Each variable was analyzed in 3 distinct moments: preoperative evaluation, 2-year postoperative follow-up (2-PO), and 6-year postoperative follow-up (6-PO).
There were no cases of early or late mortality. Mean BMI at preoperative evaluation, 2-PO, and 6-PO were 28.1 ± 1.2; 23.2 ± 2.4; and 24.7 ± 3.1, respectively. The lowest BMI at 6-PO was 19.1 kg/m2. Complete remission of T2D was achieved in 16.7%, partial remission in another 16.7%, glycemic control in 25%, and glycemic improvement in 25% of the sample at 6-PO; 16.7% did not present positive glycemic outcomes. Only 1 patient needed to resume insulin administration between 2-PO and 6-PO.
RYGB was found to be safe and effective in treating uncontrolled T2D in non-obese patients, providing improvements in the glycemic patterns in 83.4% of our sample.
-RYGB was safe in non-obese patients, with no cases of early nor late mortality.-There were no cases of very low BMI at the end of the study period.-83.4% of the sample experienced improvements in their glycemic patterns.-33.4% experienced remission of diabetes, either partial or complete.