Improvement of type 2 diabetes mellitus after gastric cancer surgery: Short-term outcome analysis after gastrectomy

doi:10.3748/wjg.v19.i48.9410

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Dec 28, 2013; 19(48): 9410-9417
Published online Dec 28, 2013. doi: 10.3748/wjg.v19.i48.9410

Table 1 Patient demographics n (%)

Variables	n = 64
Age (yr)	62.7 ± 8.6
Range	45-77
Sex
Male	43 (67.2)
Female	21 (32.8)
Body mass index (kg/m²)	24.7 ± 3.4
Range	18.6-38.1
Smoking history
No	36 (56.2)
Yes	28 (43.8)
Alcohol history
No	38 (59.4)
Yes	26 (40.6)
Family history of DM
No	52 (81.2)
Yes	12 (18.8)
Operation type
STG BI	36 (56.2)
STG BII	16 (25.0)
TG	12 (18.8)
Surgical approach
Open surgery	28 (43.7)
Laparoscopic surgery	36 (56.3)
Duration of DM (yr)	6.6 ± 6.4
Range	0.5-25
DM medication
Oral hyperglycemic agents	60 (93.7)
Insulin only	1 (1.6)
Both	3 (4.7)

Data are expressed as absolute numbers (percentage) or mean ± SD. DM: Diabetes mellitus; STG BI: Subtotal gastrectomy with Billroth I anastomosis; STG BII: Subtotal gastrectomy with Billroth II anastomosis; TG: Total gastrectomy.

Table 2 Changes in biochemical data after surgery according to the follow up period and operation type

	Operation type	Preoperative	PO 3 mo	PO 6 mo	PO 12 mo	¹P pre-12 mo
BMI (kg/m²)	STG BI	24.3 ± 2.9	22.5 ± 2.6	22.3 ± 2.8	21.9 ± 2.7	< 0.001
	STG BII	24.7 ± 3.1	22.6 ± 2.9	22.9 ± 2.1	22.1 ± 1.9	0.002
	TG	25.7 ± 5.2	23.8 ± 5.7	22.5 ± 4.6	22.9 ± 4.4	0.004
	²P	0.793	0.965	0.616	0.780
BMI	STG BI	100%	92.9% ± 5.2%	92.2% ± 5.3%	92.0% ± 7.0%	< 0.001
	STG BII	100%	91.6% ± 6.7%	93.3% ± 6.9%	90.3% ± 11.0%	0.004
	TG	100%	90.9% ± 6.4%	87.8% ± 5.7%	87.1% ± 8.1%	0.003
	²P	1.000	0.661	0.050	0.333
Glucose (mg/dL)	STG BI	147.3 ± 44.1	125.0 ± 30.3	122.3 ± 38.4	114.4 ± 21.7	0.001
	STG BII	155.7 ± 40.0	136.4 ± 56.6	122.5 ± 31.9	126.4 ± 39.1	0.061
	TG	145.9 ± 37.5	114.3 ± 22.2	117.0 ± 28.0	115.4 ± 27.3	0.234
	²P	0.682	0.489	0.931	0.773
HbA1c	STG BI	7.2% ± 1.1%	6.8% ± 0.6%	7.0% ± 0.7%	7.1% ± 0.9%	0.834
	STG BII	7.3% ± 1.3%	6.9% ± 1.4%	7.1% ± 1.3%	7.1% ± 1.6%	0.626
	TG	7.1% ± 0.8%	6.5% ± 0.7%	6.5% ± 0.5%	6.5% ± 0.6%	0.119
	²P	0.981	0.227	0.201	0.201
Insulin (μIU/mL)	STG BI	21.3 ± 20.7	8.6 ± 11.2	8.1 ± 11.3	5.1 ± 4.7	< 0.001
	STG BII	22.5 ± 29.0	9.6 ± 8.8	8.9 ± 3.5	7.7 ± 7.1	0.041
	TG	18.1 ± 10.1	7.5 ± 5.7	4.0 ± 2.1	3.7 ± 1.9	0.02
	²P	0.679	0.652	0.050	0.350
C-peptide (ng/mL)	STG BI	3.4 ± 2.3	2.1 ± 1.6	2.3 ± 1.2	1.5 ± 0.8	< 0.001
	STG BII	3.3 ± 1.8	2.0 ± 1.4	2.4 ± 0.9	2.1 ± 1.5	0.028
	TG	2.8 ± 1.3	2.1 ± 1.2	1.5 ± 1.3	1.6 ± 0.6	0.02
	²P	0.877	0.778	0.597	0.523
HOMA-IR	STG BI	8.7 ± 10.1	2.9 ± 4.7	2.6 ± 7.9	1.3 ± 0.9	0.001
	STG BII	9.3 ± 13.5	3.3 ± 3.4	2.9 ± 2.0	2.5 ± 2.5	0.045
	TG	7.1 ± 4.1	2.1 ± 1.6	0.8 ± 0.2	1.1 ± 0.6	0.015
	²P	0.660	0.484	0.036	0.176
TG (mg/dL)	STG BI	126.1 ± 80.8	100.1 ± 51.6	115.9 ± 62.6	101.4 ± 41.7	0.341
	STG BII	144.8 ± 102.6	118.5 ± 75.9	124.3 ± 53.7	105.2 ± 44.6	0.114
	TG	143.5 ± 88.9	130.5 ± 71.4	72.3 ± 36.6	96.6 ± 37.3	0.082
	²P	0.831	0.503	0.130	0.937
LDL (mg/dL)	STG BI	96.8 ± 34.7	89.0 ± 27.9	81.3 ± 23.5	90.8 ± 29.2	0.522
	STG BII	97.4 ± 28.7	97.9 ± 33.5	94.4 ± 29.7	101.6 ± 37.5	0.515
	TG	113.6 ± 28.9	99.8 ± 28.0	63.5 ± 32.0	98.5 ± 32.0	0.023
	²P	0.299	0.556	0.192	0.594
HDL (mg/dL)	STG BI	43.9 ± 10.6	48.3 ± 11.4	49.4 ± 15.1	52.0 ± 15.1	0.002
	STG BII	43.2 ± 9.2	42.6 ± 8.2	46.2 ± 10.6	46.5 ± 8.6	0.173
	TG	42.4 ± 10.5	45.0 ± 7.3	48.7 ± 3.2	46.3 ± 8.1	0.073
	²P	0.953	0.161	0.757	0.552

¹Paired t-test, mean ± SD;

²Kruskal-Wallis test was used to evaluate the difference by operation type at the same follow up period. Significant values are indicated in bold face. BMI: Body mass index, BMI (%) refers to percentage of BMI at each follow-up compared to preoperative BMI. STG BI: Subtotal gastrectomy with Billroth I anastomosis; STG BII: Subtotal gastrectomy with Billroth II anastomosis; TG: Total gastrectomy; HOMA-IR: Homeostasis model assessment-estimated insulin resistance; LDL: Low-density lipoprotein; HDL: High-density lipoprotein.

Table 3 Degree of diabetes mellitus control after surgery n (%)

	STG BI (n = 36)			STG BII (n = 16)			TG (n = 12)
	3 mo	6 mo	12 mo	3 mo	6 mo	12 mo	3 mo	6 mo	12 mo
Stationary	16 (44.4)	16 (44.4)	15 (41.7)	8 (50)	8 (50)	6 (37.5)	6 (50)	7 (58.3)	6 (50)
Improved	19 (52.8)	20 (62.5)	21 (58.3)	8 (50)	8 (50)	9 (56.2)	6 (50)	4 (33.3)	5 (41.7)
Remission	1 (2.8)	0	0	0	0	1 (6.2)	0	1 (8.3)	1 (8.3)
Medication stopped	6 (16.7)	6 (16.7)	6 (16.7)	2 (12.5)	2 (12.5)	4 (25)	3 (25)	3 (25)	3 (25)

Stationary: No change in medication, or patients except improved and remission criteria; Improved: Reduced medication and a reduction in fasting blood glucose (FBS) or HbA1c; Remission: No medication and FBS < 126 mg/dL and HbA1c < 6.0%. STG BI: Subtotal gastrectomy with Billroth I anastomosis; STG BII: Subtotal gastrectomy with Billroth II anastomosis; TG: Total gastrectomy.

Table 4 Factors for diabetic control at postoperative 12 mo n (%)

	Stationary (n = 27)	Improved or remission (n = 37)	¹P (univariate)
Age (yr)	64.3 ± 7.2	62.2 ± 8.4	0.582²
Sex			0.789
Male	19 (44.2)	24 (55.8)
Female	8 (38.1)	13 (61.9)
BMI, preop (kg/m²)	24.5 ± 4.0	24.9 ± 3.0	0.434²
BMI
3 mo	94.4% ± 5.0%	91.2% ± 5.3%	0.018²
6 mo	93.7% ± 6.8%	90.4% ± 5.7%	0.036²
12 mo	93.8% ± 9.1%	88.9% ± 7.8%	0.041²
Smoking			0.043
Yes	16 (57.1)	12 (42.9)
No	11 (30.6)	25 (69.4)
Alcohol history			0.132
No	13 (34.2)	25 (65.8)
Yes	14 (53.8)	12 (46.2)
DM duration (yr)			0.013
> 10	10 (76.9)	3 (23.1)
5-10	8 (40.0)	12 (60.0)
< 5	9 (29.0)	22 (71.0)
Family history of DM			1.000
No	22 (42.3)	30 (57.7)
Yes	5 (41.7)	7 (58.3)
Operation type			0.799
STG BI	15 (41.7)	21 (58.3)
STG BII	6 (37.5)	10 (62.5)
TG	6 (50.0)	6 (50.0)
Preop FBS	152.1 ± 43.6	145.6 ± 40.3	0.624²
Preop HbA1c	6.9 ± 0.8	7.4 ± 1.2	0.313²
Preop Insulin	21.7 ± 26.3	19.0 ± 17.8	0.804²
Preop C-peptide	3.1 ± 2.2	3.3 ± 1.9	0.509²
Preop HOMA-IR	9.2 ± 12.8	7.3 ± 8.0	0.835²

¹χ²;

²Mann-Whitney U test, mean ± SD. Significant values are indicated in bold face. BMI: Body mass index, BMI (%) refers to the percentage of BMI at postoperative follow-up. DM: Diabetes mellitus; STG BI: Subtotal gastrectomy with Billroth I anastomosis; STG BII: Subtotal gastrectomy with Billroth II anastomosis; TG: Total gastrectomy; FBS: Fasting blood glucose; HOMA-IR: Homeostasis model assessment-estimated insulin resistance.

Table 5 Multivariate analysis of predictive factors for diabetic control at postoperative 12 mo

Variables	Odds ratio	95%CI	¹P
Sex
Male
Female	0.168	0.018-1.529	0.113
Smoking
Yes
No	12.636	0.946-124.216	0.068
BMI (%)
3 mo	0.869	0.690-1.094	0.232
6 mo	0.839	0.626-1.125	0.240
12 mo	1.055	0.893-1.246	0.526
DM duration (yr)
> 10
5-10	27.505	2.174-347.988	0.010
< 5	10.583	0.808-138.670	0.072
Operation type
STG BI
STG BII	0.547	0.086-3.493	0.523
TG	0.088	0.006-1.365	0.088

¹Binary logistic regression. STG BI: Subtotal gastrectomy with Billroth I anastomosis; STG BII: Subtotal gastrectomy with Billroth II anastomosis; TG: Total gastrectomy.

Citation: An JY, Kim YM, Yun MA, Jeon BH, Noh SH. Improvement of type 2 diabetes mellitus after gastric cancer surgery: Short-term outcome analysis after gastrectomy. World J Gastroenterol 2013; 19(48): 9410-9417
URL: https://www.wjgnet.com/1007-9327/full/v19/i48/9410.htm
DOI: https://dx.doi.org/10.3748/wjg.v19.i48.9410