Amelioration of Insulin Requirement in Patients Undergoing Duodenal Bypass for Reasons Other than Obesity Implicates Foregut Factors in the Pathophysiology of Type II Diabetes

Emmanuel E. Zervos, Steven Agle, Alex J. Warren, Christina G. Lang, Timothy L. Fitzgerald, Moahad Dar, Michael F. Rotondo, Walter J. Pories

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: Foregut diversion and weight loss have been proposed as potential mechanisms for resolution of type II diabetes mellitus (T2DM) observed in patients undergoing gastric bypass for obesity. To support or refute the role of the foregut, we analyzed glycemic control in T2DM patients before and after foregut bypass for reasons other than morbid obesity. Study Design: Using ICD9/CPT codes, we identified patients undergoing Roux-en-Y gastrojejunostomy (RY) or Billroth II (BII) reconstruction over 10 years. Fasting blood glucose, insulin or oral diabetic agent requirement, and body mass index (BMI) before and after surgery were tabulated and compared using the Student's t-test. Linear regression was applied to determine specific factors predictive of resolution or improvement in glycemic control including age, duration of diabetes, antidiabetic regimen, type of operation, and surgical indication. Results: Between 1996 and 2006, we identified 24 patients with T2DM out of a cohort of 209 who underwent either RY (12 of 24) or BII reconstruction (12 of 24) for cancer or peptic ulcer disease and survived more than 30 days after operation. Of this group, 75% were overweight (18 of 24 with BMI <30 kg/m2) and 25% were class I morbidly obese (6 of 24 with BMI 30 to 35 kg/m2). Seventeen patients (71%) had either complete resolution (7 of 24 or 29%) or significant reduction (10 of 24 or 42%) in medication requirements; 7 patients (29%) did not have any improvement. Logistic regression failed to identify specific factors predicting improved glycemic control. Conclusions: Complete resolution of T2DM in patients undergoing duodenal diverting surgery occurs in about one-third of nonobese patients. Improved glycemic control occurs in more than two-thirds and cannot be explained by surgically related weight loss alone. Surgical cure of T2DM may be possible in carefully selected nonobese patients.

Original languageEnglish (US)
Pages (from-to)564-572
Number of pages9
JournalJournal of the American College of Surgeons
Volume210
Issue number5
DOIs
StatePublished - May 2010
Externally publishedYes

Fingerprint

Type 2 Diabetes Mellitus
Obesity
Insulin
Gastric Bypass
Gastroenterostomy
Body Mass Index
Weight Loss
Current Procedural Terminology
Morbid Obesity
Peptic Ulcer
Hypoglycemic Agents
Blood Glucose
Linear Models
Fasting
Logistic Models
Students
Neoplasms

ASJC Scopus subject areas

  • Surgery

Cite this

Amelioration of Insulin Requirement in Patients Undergoing Duodenal Bypass for Reasons Other than Obesity Implicates Foregut Factors in the Pathophysiology of Type II Diabetes. / Zervos, Emmanuel E.; Agle, Steven; Warren, Alex J.; Lang, Christina G.; Fitzgerald, Timothy L.; Dar, Moahad; Rotondo, Michael F.; Pories, Walter J.

In: Journal of the American College of Surgeons, Vol. 210, No. 5, 05.2010, p. 564-572.

Research output: Contribution to journalArticle

Zervos, Emmanuel E. ; Agle, Steven ; Warren, Alex J. ; Lang, Christina G. ; Fitzgerald, Timothy L. ; Dar, Moahad ; Rotondo, Michael F. ; Pories, Walter J. / Amelioration of Insulin Requirement in Patients Undergoing Duodenal Bypass for Reasons Other than Obesity Implicates Foregut Factors in the Pathophysiology of Type II Diabetes. In: Journal of the American College of Surgeons. 2010 ; Vol. 210, No. 5. pp. 564-572.
@article{437e84f5432841b792e56af310965ac5,
title = "Amelioration of Insulin Requirement in Patients Undergoing Duodenal Bypass for Reasons Other than Obesity Implicates Foregut Factors in the Pathophysiology of Type II Diabetes",
abstract = "Background: Foregut diversion and weight loss have been proposed as potential mechanisms for resolution of type II diabetes mellitus (T2DM) observed in patients undergoing gastric bypass for obesity. To support or refute the role of the foregut, we analyzed glycemic control in T2DM patients before and after foregut bypass for reasons other than morbid obesity. Study Design: Using ICD9/CPT codes, we identified patients undergoing Roux-en-Y gastrojejunostomy (RY) or Billroth II (BII) reconstruction over 10 years. Fasting blood glucose, insulin or oral diabetic agent requirement, and body mass index (BMI) before and after surgery were tabulated and compared using the Student's t-test. Linear regression was applied to determine specific factors predictive of resolution or improvement in glycemic control including age, duration of diabetes, antidiabetic regimen, type of operation, and surgical indication. Results: Between 1996 and 2006, we identified 24 patients with T2DM out of a cohort of 209 who underwent either RY (12 of 24) or BII reconstruction (12 of 24) for cancer or peptic ulcer disease and survived more than 30 days after operation. Of this group, 75{\%} were overweight (18 of 24 with BMI <30 kg/m2) and 25{\%} were class I morbidly obese (6 of 24 with BMI 30 to 35 kg/m2). Seventeen patients (71{\%}) had either complete resolution (7 of 24 or 29{\%}) or significant reduction (10 of 24 or 42{\%}) in medication requirements; 7 patients (29{\%}) did not have any improvement. Logistic regression failed to identify specific factors predicting improved glycemic control. Conclusions: Complete resolution of T2DM in patients undergoing duodenal diverting surgery occurs in about one-third of nonobese patients. Improved glycemic control occurs in more than two-thirds and cannot be explained by surgically related weight loss alone. Surgical cure of T2DM may be possible in carefully selected nonobese patients.",
author = "Zervos, {Emmanuel E.} and Steven Agle and Warren, {Alex J.} and Lang, {Christina G.} and Fitzgerald, {Timothy L.} and Moahad Dar and Rotondo, {Michael F.} and Pories, {Walter J.}",
year = "2010",
month = "5",
doi = "10.1016/j.jamcollsurg.2009.12.025",
language = "English (US)",
volume = "210",
pages = "564--572",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Amelioration of Insulin Requirement in Patients Undergoing Duodenal Bypass for Reasons Other than Obesity Implicates Foregut Factors in the Pathophysiology of Type II Diabetes

AU - Zervos, Emmanuel E.

AU - Agle, Steven

AU - Warren, Alex J.

AU - Lang, Christina G.

AU - Fitzgerald, Timothy L.

AU - Dar, Moahad

AU - Rotondo, Michael F.

AU - Pories, Walter J.

PY - 2010/5

Y1 - 2010/5

N2 - Background: Foregut diversion and weight loss have been proposed as potential mechanisms for resolution of type II diabetes mellitus (T2DM) observed in patients undergoing gastric bypass for obesity. To support or refute the role of the foregut, we analyzed glycemic control in T2DM patients before and after foregut bypass for reasons other than morbid obesity. Study Design: Using ICD9/CPT codes, we identified patients undergoing Roux-en-Y gastrojejunostomy (RY) or Billroth II (BII) reconstruction over 10 years. Fasting blood glucose, insulin or oral diabetic agent requirement, and body mass index (BMI) before and after surgery were tabulated and compared using the Student's t-test. Linear regression was applied to determine specific factors predictive of resolution or improvement in glycemic control including age, duration of diabetes, antidiabetic regimen, type of operation, and surgical indication. Results: Between 1996 and 2006, we identified 24 patients with T2DM out of a cohort of 209 who underwent either RY (12 of 24) or BII reconstruction (12 of 24) for cancer or peptic ulcer disease and survived more than 30 days after operation. Of this group, 75% were overweight (18 of 24 with BMI <30 kg/m2) and 25% were class I morbidly obese (6 of 24 with BMI 30 to 35 kg/m2). Seventeen patients (71%) had either complete resolution (7 of 24 or 29%) or significant reduction (10 of 24 or 42%) in medication requirements; 7 patients (29%) did not have any improvement. Logistic regression failed to identify specific factors predicting improved glycemic control. Conclusions: Complete resolution of T2DM in patients undergoing duodenal diverting surgery occurs in about one-third of nonobese patients. Improved glycemic control occurs in more than two-thirds and cannot be explained by surgically related weight loss alone. Surgical cure of T2DM may be possible in carefully selected nonobese patients.

AB - Background: Foregut diversion and weight loss have been proposed as potential mechanisms for resolution of type II diabetes mellitus (T2DM) observed in patients undergoing gastric bypass for obesity. To support or refute the role of the foregut, we analyzed glycemic control in T2DM patients before and after foregut bypass for reasons other than morbid obesity. Study Design: Using ICD9/CPT codes, we identified patients undergoing Roux-en-Y gastrojejunostomy (RY) or Billroth II (BII) reconstruction over 10 years. Fasting blood glucose, insulin or oral diabetic agent requirement, and body mass index (BMI) before and after surgery were tabulated and compared using the Student's t-test. Linear regression was applied to determine specific factors predictive of resolution or improvement in glycemic control including age, duration of diabetes, antidiabetic regimen, type of operation, and surgical indication. Results: Between 1996 and 2006, we identified 24 patients with T2DM out of a cohort of 209 who underwent either RY (12 of 24) or BII reconstruction (12 of 24) for cancer or peptic ulcer disease and survived more than 30 days after operation. Of this group, 75% were overweight (18 of 24 with BMI <30 kg/m2) and 25% were class I morbidly obese (6 of 24 with BMI 30 to 35 kg/m2). Seventeen patients (71%) had either complete resolution (7 of 24 or 29%) or significant reduction (10 of 24 or 42%) in medication requirements; 7 patients (29%) did not have any improvement. Logistic regression failed to identify specific factors predicting improved glycemic control. Conclusions: Complete resolution of T2DM in patients undergoing duodenal diverting surgery occurs in about one-third of nonobese patients. Improved glycemic control occurs in more than two-thirds and cannot be explained by surgically related weight loss alone. Surgical cure of T2DM may be possible in carefully selected nonobese patients.

UR - http://www.scopus.com/inward/record.url?scp=77952304122&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77952304122&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2009.12.025

DO - 10.1016/j.jamcollsurg.2009.12.025

M3 - Article

VL - 210

SP - 564

EP - 572

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 5

ER -