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The foregut theory as a possible mechanism of action for the remission of type 2 diabetes in low body mass index patients undergoing subtotal gastrectomy for gastric cancer

Authors
Kwon, YeongkeunAbdemur, AbrahamLo Menzo, EmanuelePark, SungsooSzomstein, SamuelRosenthal, Raul J.
Issue Date
3월-2014
Publisher
ELSEVIER SCIENCE INC
Keywords
Metabolic surgery; Subtotal gastrectomy; Billroth; Type 2 diabetes; Gastric cancer
Citation
SURGERY FOR OBESITY AND RELATED DISEASES, v.10, no.2, pp.235 - 242
Indexed
SCIE
SCOPUS
Journal Title
SURGERY FOR OBESITY AND RELATED DISEASES
Volume
10
Number
2
Start Page
235
End Page
242
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/99242
DOI
10.1016/j.soard.2013.09.013
ISSN
1550-7289
Abstract
Background: The question of whether pure metabolic surgery could be used in nonobese patients with type 2 diabetes has been considered. The objective of this study was to assess the comparative effects of the Billroth I (BI) and Billroth II (BII) reconstruction methods on remission of type 2 diabetes in nonobese patients undergoing subtotal gastrectomy for cancer. Methods: The charts of 404 patients who underwent radical subtotal gastrectomy for cancer between January 2008 and December 2010 were retrospectively reviewed. From these patients, 49 with type 2 diabetes were included in this study. Diabetes remission rates, the percentage change in fasting plasma glucose levels, glycated hemoglobin levels, body mass index, and fasting total cholesterol levels at 2 years were observed. Outcomes were compared using propensity scores and inverse probability-weighting adjustment that reduced treatment-selection bias. Covariate-adjusted logistic regression models were assessed. Results: The 2-year diabetes remission rate for the 23 patients who underwent BI reconstruction was 39.1%, compared with 50.0% for the 26 patients who underwent BB reconstruction. At 2 years, the BII group showed lower glycated hemoglobin levels (BI, 6.4%; BII, 6.1%; P = .003) and had greater percent reductions in their average glycated hemoglobin levels from baseline (BI, -11.6%; BII, -14.5%; P = .043). BII reconstruction was significantly associated with an increased diabetes remission rate (odds ratio, 3.22; 95% confidence interval, 1.05-9.83) in covariate-adjusted logistic regression analysis. Conclusions: These propensity score-adjusted analyses of patients who had undergone subtotal gastrectomy indicated that BII reconstruction was associated with increased diabetes remission compared with BI reconstruction during the 2-year follow-up period. This study suggests the possibility of employing the surgical duodenal switch for the treatment of nonobese type 2 diabetes patients. (C) 2014 American Society for Metabolic and Bariatric Surgery. All rights reserved.
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