Journal List > J Korean Surg Soc > v.79(1) > 1011219

Lee, Kim, Kwon, Song, and Kim: The Impact of Metabolic and Bariatric Surgery on Morbidly Obese Patients with Type 2 DM

Abstract

Purpose

Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) are the most effective intervention and cure in achieving sustained weight loss in the morbidly obese with co-morbities, especially in type 2 diabetes mellitus (DM). Currently, there are few data in the literature presenting early diabetic outcomes between the 2 major bariatric surgeries in Korea. The aim of this study is to observe weight loss, improvement of type 2 DM after LRYGB and LAGB.

Methods

33 retrospective data were obtained from diabetic subjects undergoing LRYGB (n=53) and LAGB (n=77). These measurements included age, sex, body mass index (BMI), pre-operative diabetic duration, post-operative diabetic at follow-up visit after surgery. Paired t-test, and SPSS12.0 were used for statistical analysis.

Results

33 morbidly obese patients with type 2 DM who had both procedures complain of general weakness. Most patients were taking oral medications or insulin and tired of them. Pre and post-op 12 months of percent of excess weight loss (%EWL), fetal bovine serum (FBS), hemoglobin A1c (HbA1C) presented at 0%, 185.6 mg/dl, 8.7% and 70.6%, 123.4 mg/dl, 6.6% in patients who had LRYGB (P<0.05). Pre and post-op 12 months of %EWL, FBS, HbA1C presented at 0%, 180.6 mg/dl, 8.4% and 32.8%, 136.5 mg/dl, 6.8% in patients who had LAGB (P<0.05). Rate of discontinuance or decreasing for treatment of type 2 DM after surgery showed 94% for LRYGB versus 80% for LAGB, and unchanged rates were 6% versus 20%, respectively.

Conclusion

This study showed LRYGB and LAGB are quite satisfactory and promising bariatric procedures with significant weight loss and improvement of type 2 DM in Koreans. LRYGB is significantly associated with more weight loss, more diabetic outcome than LAGB. Clinical experiences in Korea with both procedures are limited and a larger number of cases are need, but the recent data shows promising results that are comparable to the international experience.

Figures and Tables

Table 1
Demographics of type 2 diabetes mellitus, patients who had undergone 2 main bariatric surgeries
jkss-79-8-i001

*LRYGB = laparoscopic Roux-en-Y gastric bypass; LAGB = laparoscopic adjustable gastric banding; BMI = body mass index; §OA = oral agents.

Table 2
Changes of %EWL, FBS, & HbA1c after LRYGB and LAGB (mean)
jkss-79-8-i002

*LRYGB = laparoscopic Roux-en-Y gastric bypass; LAGB = laparoscopic adjustable gastric banding; %EWL = percent of excess weight loss; §FBS = fetal bovine serum; HbA1c = hemoglobin A1c.

Table 3
Changes of the management for diabetes 24 months after surgery
jkss-79-8-i003

*LRYGB = laparoscopic Roux-en-Y gastric bypass; LAGB = laparoscopic adjustable gastric banding; OA = oral agents; §No change pre and post operation of diabetic treatment.

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