Defining and predicting complete remission of type 2 diabetes: A short-term efficacy study of open gastric bypass

摘要

Objective: To investigate the metabolic effects of open Roux-en Y gastric bypass (RYGB) on pancreatic endocrine reserve in overweight/obese Chinese patients with type 2 diabetes during postoperative year 1. Methods: Retrospective analysis comparing pre- and postoperative results of oral glucose tolerance tests (OGTT) with determinations of insulin and C-peptide, glycated hemoglobin (HbA1c), insulin resistance (HOMA-IR), and BMI at 1, 3, 6, and 12 months in 99 overweight patients (BMI 26.3 ± 4.0 kg/m2; 59 men) with type 2 diabetes at the General Hospital of Chengdu Military Region. Results: 79 patients (80%) achieved complete remission (maintaining random blood glucose levels 11.1 mmol/l, fasting blood glucose levels 7.0 mmol/l, 2-hour OGTT blood glucose levels 11.1 mmol/l, and glycated hemoglobin 6.5%). Nine cases (9%) were 'improved' (reduced medication or diet controlled blood sugar), and 11 cases did not meet either criterion ('unchanged'). Patients in complete remission were younger and heavier, more often men, had significantly shorter history of diabetes (4.3 ± 3.8 years vs. 7.6 ± 3.8 years, p 0.05), and exhibited significantly higher fasting and OGTT levels of C-peptide and insulin, and HOMA-IR than the other 2 groups (p 0.05-0.01). Conclusion: Open gastric bypass achieved complete remission of type 2 diabetes in Chinese overweight/obese, heavier, younger, predominantly male patients with shorter duration of disease exhibiting greater pancreatic endocrine reserve.