Does Reconstruction Type After Gastric Resection Matters for Type 2 Diabetes Improvement?

Area of Science:

• Gastroenterology
• Endocrinology
• Surgical Oncology

Background:

• Gastrointestinal (GI) surgery, including gastric resection and intestinal bypass, is known to improve glucose control in obese patients with type 2 diabetes (T2D).
• The impact of specific GI reconstruction techniques on glucose metabolism in non-obese T2D patients undergoing surgery for reasons other than bariatric intervention remains less understood.

Purpose of the Study:

• To evaluate if the type of post-gastrectomy GI reconstruction influences glucose control in T2D patients with a body mass index (BMI) below 35 kg/m² undergoing gastrointestinal surgery without bariatric intent.

Main Methods:

• A cohort of 40 Caucasian T2D patients (33 with upper GI malignancy, 7 with complicated reflux disease) were analyzed.
• Patients underwent either Billroth II (BII) gastrojejunal anastomosis (n=17), Roux-en-Y (RY) gastrojejunostomy (n=18), or no reconstruction (no-R) (n=5) after gastrectomy.
• Evaluations included body weight, HbA1c, glucose-lowering drug requirements, and diabetes status before and 2 years post-surgery.

Main Results:

• All surgical procedures led to a decrease in BMI. RY and no-R reconstructions showed a significantly greater BMI reduction compared to BII.
• Diabetes remission was observed in 5.9% of BII patients, 27.8% of RY patients, and 0% of no-R patients.
• Among patients with persistent T2D, RY reconstruction significantly reduced the need for glucose-lowering drugs compared to BII (66.7% vs 31.3%).

Conclusions:

• Post-gastrectomy GI reconstructions, particularly RY, can significantly improve T2D control in patients without a bariatric indication.
• The choice of GI reconstruction technique may influence the degree of T2D improvement.
• Consideration of T2D status is crucial when selecting the type of post-gastrectomy GI reconstruction.