Metabolic laparoscopic gastric bypass for obese patients with type 2 diabetes

Bariatric surgery has been proposed as the most effective treatment for patients with type 2 diabetes mellitus (T2DM) and body mass index (BMI) above 35 kg/m(2). The purpose of our study was to access remission rate and improvement of metabolic control of T2DM after gastric bypass.

A prospective study was carried out on 94 diabetic patients, who underwent gastric bypass with a 200-cm biliopancreatic limb. Characteristics evaluated included weight, BMI, percentage of excess BMI lost (% EBMIL), fasting glucose, HbA1c, and lipid profile up to 36 months after surgery, as well as anti-diabetic treatment before and after surgery.

At the time of surgery, patients had a mean BMI of 44.3 ± 0.65 kg/m(2) and length of T2DM diagnosis of 6.2 ± 0.98 years and HbA1c of 6.6 ± 0.21%. After a mean time of follow-up of 2.6 ± 0.13 years, the weight loss was significant from 3 months onwards after surgery, reaching its peak at 24 months with a BMI of 32.1 ± 0.9 kg/m(2) and corresponding % EBMIL of 69.0 ± 2.84%. Remission rates of diabetes were 87.91% at 6 months, 92.68% at 12 months, 92.85% at 24 months, and 100% at 36 months of follow-up.

Gastric bypass in obese patients is associated with a high remission rate of diabetes and improvement of the metabolic control. Although confirmation with randomized controlled studies is needed, these results suggest that this type of surgery might be particularly indicated for obese diabetic patients with good pancreatic reserve.