Effect Of Different Gastric Volume On Non-obese Patients With Type2Diabetes Mellitus

【Objective】To investigate the effect of different gastrointestinal anastomosis and gastricvolume on non-obese patients with type2diabetes mellitus, and to find out therelationship between the size of the stomach volume and glycemic control, and toexplore the feasibility of the surgery for the non-obese patients with type2diabetes mellitus and the possible mechanisms for the glycemic control, with aview to provide a theoretical basis for the non-obese patients with type2diabetesmellitus to the surgery and for the surgical improvements.【Methods】From July2010to May2011,49non-obese patients with gastroduodenaldisease and type2diabetes mellitus underwent gastrectomy in the department ofgeneral surgery were prospectively assigned into5groups. Based on the location,size, type of the disease during the surgery, patients were underwent Roux-en-Ygastric bypass with total gastrectomy (Group A), Roux-en-Y gastric bypass withsubtotal gastrectomy (Group B), Roux-en-Y gastric bypass with partialgastrectomy (Group C), distal gastrectomy with BillrothⅠanastomosis(Group D)and proximal gastrectomy with remanant gastric esophageal anastomosis(GroupE). The body mass index(BMI), fasting plasma glucose(FPG), glycosylatedhemoglobin(HbA1c), and the fasting C-peptide were analyzed before surgery (0month) and1,3,6months after surgery, and the efficiency of the surgery wasanalyzed6month after surgery.【Results】1. Body mass index(BMI)Compared with preoperation, the body mass index was significantlydecreased after surgery during the entire follow-up period in the five groups(P<0.01); However, no significant differences can be found among the five groups during follow-up period at the same time(P>0.05), which means differentgastrointestinal anastomosis and gastric volume have no effect on BMI for thepatients.2. Fasting blood glucose (FPG)The fasting blood glucose (FPG) in the five groups have no differencesbefore operation (P>0.05). Compared with preoperation, the fasting plasmaglucose was significantly decreased after surgery on the Roux-en-Y gastricbypass groups (Group A, Group B, Group C)(P<0.05or P<0.01), but nosignificant changes can be found on the non-gastric bypass groups (Group D,Group E)(P>0.05) during the entire follow-up period. No significant differencescan be found among the Roux-en-Y gastric bypass groups during the follow-upperiod at the same time (P>0.05), but as to the Roux-en-Y gastric bypass groups(Group A, Group B, Group C) and non-gastric bypass groups (Group D, GroupE), differences were statistically significant (P<0.05or P<0.01).3. Glycosylated hemoglobin(HbA1c)Glycosylated hemoglobin (HbA1c) in the five groups have no differencesbefore operation (P>0.05). Compared with preoperation, the glycosylatedhemoglobin has no significantly changes1month after surgery in the five groups(P>0.05), but it was significantly decreased on the Roux-en-Y gastric bypassgroups (Group A, Group B, Group C)(P<0.05or P<0.01) and increased on thenon-gastric bypass groups (Group D, Group E)(P<0.05or P<0.01) from3monthto6month after surgery. No significant differences can be found among the fivegroups1month after surgery (P>0.05). From3month to6month after surgery atthe same time point, no significant differences can be found among theRoux-en-Y gastric bypass groups (P>0.05), but as to the Roux-en-Y gastricbypass groups (Group A, Group B, Group C) and non-gastric bypass groups(Group D, Group E), differences were statistically significant (P<0.01).4. Fasting C-peptideCompared with preoperation, the fasting C-peptide was significantlyincreased on the Roux-en-Y gastric bypass groups (Group A, Group B, Group C) (P<0.05or P<0.01), but no significant changes can be found on the non-gastricbypass groups (Group D, Group E)(P>0.05) during the entire follow-up period.No significant differences can be found among the Roux-en-Y gastric bypassgroups during follow-up period at the same time (P>0.05), but as to theRoux-en-Y gastric bypass groups (Group A, Group B, Group C) and non-gastricbypass groups (Group D, Group E), differences were statistically significant(P<0.05or P<0.01).5. Efficacy of the surgery6patients were cured,3patients were improved,1case was invalid inGroup A;8patients were cured,5cases were improved,1case was ineffective inGroup B;5patients were cured,1patient was improved in Group C;2patientswere improved,9cases were ineffective in Group D;1patient was improved,7cases were ineffective in Group E; by Ridit statistical analysis, no statisticallysignificant difference can be found on the Roux-en-Y gastric bypass groups(Group A, Group B, Group C)(P>0.05), but as to the Roux-en-Y gastric bypassgroups (Group A, Group B, Group C) and non-gastric bypass groups (Group D,Group E), differences was statistically significant (P<0.01).【Conclusions】1. Roux-en-Y gastric bypass surgery can improve diabetes-related metabolicparameters, and was not depend on decreased body weight;2. There was no significant differences in terms of blood glucose, glycatedhemoglobin control for the Roux-en-Y gastric bypass with different stomachvolume;3. There was no significant improvement on the diabetes-related metabolicparameters in the non-bypass surgery;4. The mechanisms mediating antidiabetic effect have no obvious contactwith the stomach, but mainly on the exclusion of the duodenum and the proximaljejunum.