Early Glycemic Change After Roux-en-Y Gastric Bypass

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 807-838-Diabetes - Diagnosis, Complications & Outcomes
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-824
Barbara Gisella Carranza Leon*1, Ildiko Lingvay2 and Nancy Puzziferi2
1Mayo Clinic, Rochester, MN, 2UT Southwestern Medical Center, Dallas, TX
The mechanism by which Roux-en-Y gastric bypass (RYGB) ameliorates Type 2 Diabetes Mellitus (T2DM) is not fully understood.  Initially it was thought to be related to weight loss but different groups have shown that glycemia improves shortly after surgery before significant weight loss has occurred. This study evaluates the change in T2DM parameters in the immediate postoperative. We performed a retrospective data collection and analysis from 132 patients with the diagnosis of T2DM who underwent RYGB at the UT Southwestern University Hospitals from 2005 to 2009. Eighty percent of patients were female with a mean age of 43+/-10.9 years. Initial weight and body mass index were 140.8+/-32 kg and 50.1+/-9.9 mg/m2 respectively. Pre-operative fasting plasma glucose (FPG) was 148+/-52 mg/dl.  FPG was higher than baseline on the first 2 days postoperatively (161+/-46 mg/dl and 152+/-43 mg/dl on postoperative days 1 and 2 respectively), reflective of surgery-induced stress response, but returned to baseline by the day of discharge at 143+/-38 mg/dl. Patients were discharged 3.0+/-1.8 days after surgery. Mean average daily glucose (ADG) on the day of surgery was 187+/-43 mg/dl and rapidly improved to 145+/-40 mg/dl on the day of discharge.  At the time of discharge 3% of patients achieved remission of T2DM and 34% achieved improvement in their T2DM determined by fewer and/or lower doses requirement of diabetic medications.  For most patients the FPG /ADG remained unchanged during the hospitalization and were higher than 126 mg/dl on discharge. We believe the difference between the FPG and ADG the day of surgery is secondary to up regulation of counter-regulatory stress hormones in response to surgery.  Caloric restriction in the perioperative period plays an important role which determines the rapid resolution of T2DM, and initiates subsequent weight loss. While hormonal changes occur immediately postoperative, their link to the immediate T2DM resolution is only circumstantial, and we believe their role is mainly in sustaining a reduced appetite and caloric intake, rather than an immediate direct effect on glycemia.

Disclosure: IL: Study Investigator, Novo Nordisk, Advisory Group Member, Novo Nordisk. Nothing to Disclose: BGC, NP

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