Diabetes remission and reduced cardiovascular risk after gastric bypass in Asian Indians with body mass index <35 kg/m²

Abstract 

Background

Roux-en-Y gastric bypass (RYGB) benefits patients with type 2 diabetes mellitus (T2DM) and a body mass index (BMI) >35 kg/m²; however, its effectiveness in patients with T2DM and a BMI <35 kg/m² is unclear. Asian Indians have a high risk of T2DM and cardiovascular disease at relatively low BMI levels. We examined the safety and efficacy of RYGB in Asian Indian patients with T2DM and a BMI of 22–35 kg/m² in a tertiary care medical center.

Methods

A total of 15 consecutive patients with T2DM and a BMI of 22–35 kg/m² underwent RYGB. The data were prospectively collected before surgery and at 1, 3, 6, and 9 months postoperatively.

Results

Of the 15 patients, 8 were men and 7 were women (age 45.6 ± 12 years). Their preoperative characteristics were BMI 28.9 ± 4.0 kg/m², body weight 78.7 ± 12.5 kg, waist circumference 100.2 ± 6.8 cm, and duration of T2DM 8.7 ± 5.3 years. At baseline, 80% of subjects required insulin, and 20% controlled their T2DM with oral hypoglycemic medication. The BMI decreased postoperatively by 20%, from 28.9 ± 4.0 kg/m² to 23.0 ± 3.6 kg/m² (P <.001). All antidiabetic medications were discontinued by 1 month after surgery in 80% of the subjects. At 3 months and thereafter, 100% were euglycemic and no longer required diabetes medication. The fasting blood glucose level decreased from 233 ± 87 mg/dL to 89 ± 12 mg/dL (P <.001), and the hemoglobin A1c decreased from 10.1% ± 2.0% to 6.1% ± 0.6% (P <.001). Their waist circumference, presence of dyslipidemia, and hypertension improved significantly. The predicted 10-year cardiovascular disease risk (calculated using the United Kingdom Prospective Diabetes Study equations) decreased substantially for fatal and nonfatal coronary heart disease and stroke. No mortality, major surgical morbidity, or excessive weight loss occurred.

Conclusion

RYGB safely and effectively eliminated T2DM in Asian Indians with a BMI <35 kg/m². Larger, longer term studies are needed to confirm this benefit.

Keywords: Gastric bypass, Metabolic surgery, Bariatric surgery, Diabetes, Mortality, Cardiovascular risk, Ghrelin, Coronary heart disease