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Improved glycemic control with proximal intestinal bypass and weight loss following gastrectomy in non-obese diabetic gastric cancer patients

Authors
 Ali Guner  ;  Minah Cho  ;  Taeil Son  ;  Hyoung-Il Kim  ;  Sung Hoon Noh  ;  Woo Jin Hyung 
Citation
 Oncotarget, Vol.8(61) : 104605-104614, 2017 
Journal Title
 Oncotarget 
Issue Date
2017
Keywords
diabetes ; gastrectomy ; gastric cancer ; proximal intestinal bypass ; weight loss
Abstract
Purpose: The aim of this study was to assess whether gastrectomy influences glycemic control in non-obese diabetic gastric cancer patients and to identify factors related to glucose metabolism after gastrectomy. Materials and Methods: We retrospectively analyzed changes in glucose metabolism in 238 non-obese (body mass index < 30 kg/m2) patients with type II diabetes who underwent distal gastrectomy with either gastroduodenostomy (n = 91) or gastrojejunostomy (n = 147) for stage I gastric cancer. We collected demographics, diabetes-related features, surgery-related features, and changes in glucose metabolism during follow-up. The effect of surgery on the course of diabetes was evaluated at different time points according to fasting blood glucose levels and use of diabetes-related medication. Results: Preoperatively, the mean body mass index was 24.3 ± 2.3. Weight, body mass index and fasting blood glucose of all patients were significantly lower compared to preoperative levels at all time points. Weight loss after 6 months and the percentage of patients whose weight loss ratio was higher than 10% after one year were greater in the gastrojejunostomy group than the gastroduodenostomy group. Overall, 88 (37%) patients showed improvement in their diabetes course at one month after surgery; 152 (64%) showed improvement after 2 years. Duration of diabetes, weight loss, and reconstruction type were associated with improvement in diabetes at different time points. At 6 months and thereafter, the percentage of patients with an improved diabetes course was highest in the gastrojejunostomy plus higher than 10% weight loss group. Conclusions: Although weight loss may be associated with adverse effects of gastrectomy, postoperative weight loss in an acceptable range is a useful measure of the better glycemic control for the group of diabetic patients. Selecting gastrojejunostomy during gastrectomy and inducing acceptable weight loss after gastrectomy could be beneficial to the non-obese diabetic gastric cancer patients for improved glycemic control.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/161432
DOI
10.18632/oncotarget.22262
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실)
Yonsei Authors
김형일(Kim, Hyoung Il) ; 노성훈(Noh, Sung Hoon) ; 손태일(Son, Tae Il) ; 조민아(Cho, Minah) ; 형우진(Hyung, Woo Jin)
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