Evolution of type 2 diabetes mellitus in non morbid obese gastrectomized patients with Roux en-Y reconstruction:...

Bariatric surgery in morbidly obese patients with type 2 diabetes results systematically in adequate glycemic control, normalization of insulinemia, and a decrease in glycosylated hemoglobin, effects that appear early after surgery in nearly 80 to 90% of them. Possible reasons that have been discussed are a decrease in caloric consumption, weight loss, and hormonal changes at the gastrointestinal level, which could have a positive effect on glucose metabolism. Various authors have proposed the possibility of passing on this indication to diabetic patients who are overweight or are mildly obese. The purpose of this retrospective investigation was to determine the effect of total or subtotal gastrectomy with Roux-en-Y reconstruction on the metabolic control of patients with type 2 diabetes with a body mass index (BMI) < 35, operated on for reasons other than obesity.

From January 1999 to December 2007, a total of 23 diabetic patients who underwent total or subtotal gastrectomy with a gastrojejunal or esphagojejunal anastomosis with Roux-en-Y reconstruction of 60 to 70 cm length were included in this investigation.

The group consisted of 23 patients (14 men, 9 women, average age 62.9 +/- 7.9 years, average BMI 29.1 +/- 5.1). The principal reason for gastrectomy in these patients was gastric cancer in 19 patients (82.6%). The surgical procedure was total gastrectomy in 17 cases (73.9%) and subtotal gastrectomy in 6 cases (26.1%). Postoperative follow-up was 22 months. Before surgery the mean blood glucose level was 151.4 mg/dl. Late after surgery, 15 patients (65.2%) had a fasting blood glucose <126 mg/dl and are not using medication (remission), 7 (30.4%) patients have better metabolic control with a normal blood glucose but are still taking medication (improvement), and just 1 (4.3%) patient has an altered blood glucose and uses insulin (no change).

Gastrectomy and short Roux-en-Y limb reconstruction in type 2 diabetes patients with BMI < 35, with the patients submitted to surgery mainly for gastric cancer, correlates with remission of diabetes in 65% and improvement in 30.4%.