Maurice Youssef Franciss, Carol Viviana Serna Gonzalez, Leandro Cardoso Barchi, Myriam Boueri*, Marcus Fernando Kodama Pertille Ramos, Rodrigo Moises de Almeida Leite and Bruno Zilberstein
Volume6-Issue6
Dates: Received: 2025-05-12 | Accepted: 2025-06-06 | Published: 2025-06-08
Pages: 580-585
Abstract
Background: The effect of the duodenal exclusion in glycemic regulation has yet to be defined. Individuals with type 2 Diabetes Mellitus (T2DM) operated for other reasons than obesity, represent an adequate model to analyze clinical outcomes of duodenal exclusion.
Objective: To analyze the changes in glycemia and pharmacotherapy for T2DM in patients undergoing gastrectomy with Roux-in-Y derivation for gastric cancer.
Methods: An observational study was conducted in 2018 on patients who were submitted to surgery from 2001 to 2016. Medical records of 129 patients’ cohort operated in two public hospitals were analyzed retrospectively before the surgery (T0) and one year after (T1). The research protocol was approved by the ethics committee. The final sample was mainly represented by women (50.5%) with a mean age of 65.5 years, and a mean body mass index of 26.5 kg/m2 SD 4.30.
Results: One year later, mean glucose levels of the entire sample decreased (p=0.046), but 70% of patients with glycemia> 100 at T0, remained with the same value in T1. Glycated hemoglobin had no significant change (p=0.988). Regarding the pharmacotherapy for T2DM, 60.7% of the sample had no change. However, 6.7% had discontinuation of the medication with the improvement of T2DM. The multivariate model by classification and decision tree method (CART) found as predictors of change in DM2 medication, age (< 62.5 years) and a body mass index (> 30.2 kg/m2) with a predictive value of 71.4%.
Conclusion: There was no improvement of glycemia and pharmacotherapy in patients with T2DM who underwent gastrectomy with Roux-en-Y reconstruction, with a body mass index below 30 kg/m2
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DOI: 10.37871/jbres2113
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© 2025 Franciss MY, et al., Distributed under Creative Commons CC-BY 4.0 
How to cite this article
Franciss MY, Serna González CV, Barchi LC, Boueri M, Pertille Ramos MFK, de Almeida Leite RM, Zilberstein B. Duodenal Exclusion in the Regulation of Glycemia in Type 2 Diabetic Patients Submitted to Gastrectomy with Roux-en-Y by Gastric Cancer: Cohort Study. J Biomed Res Environ Sci. 2025 Jun 08; 6(6): 580-585. doi: 10.37871/jbres2113, Article ID: JBRES2113, Available at: https://www.jelsciences.com/articles/jbres2113.pdf
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References
- Bhupathiraju SN, Hu FB. Epidemiology of Obesity and Diabetes and Their Cardiovascular Complications. Circ Res. 2016 May 27;118(11):1723-35. doi: 10.1161/CIRCRESAHA.115.306825. PMID: 27230638; PMCID: PMC4887150.
- Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KG, Zimmet PZ, Del Prato S, Ji L, Sadikot SM, Herman WH, Amiel SA, Kaplan LM, Taroncher-Oldenburg G, Cummings DE; Delegates of the 2nd Diabetes Surgery Summit. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: a Joint Statement by International Diabetes Organizations. Obes Surg. 2017 Jan;27(1):2-21. doi: 10.1007/s11695-016-2457-9. PMID: 27957699.
- Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KG, Zimmet PZ, Del Prato S, Ji L, Sadikot SM, Herman WH, Amiel SA, Kaplan LM, Taroncher-Oldenburg G, Cummings DE; Delegates of the 2nd Diabetes Surgery Summit. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: a Joint Statement by International Diabetes Organizations. Obes Surg. 2017 Jan;27(1):2-21. doi: 10.1007/s11695-016-2457-9. PMID: 27957699.
- Campos J, Ramos A, Szego T, Zilberstein B, Feitosa H, Cohen R. THE ROLE OF METABOLIC SURGERY FOR PATIENTS WITH OBESITY GRADE I AND TYPE 2 DIABETES NOT CONTROLLED CLINICALLY. Arq Bras Cir Dig. 2016;29 Suppl 1(Suppl 1):102-106. doi: 10.1590/0102-6720201600S10025. PMID: 27409057; PMCID: PMC5064276.
- Pais R, Gribble FM, Reimann F. Stimulation of incretin secreting cells. Ther Adv Endocrinol Metab. 2016 Feb;7(1):24-42. doi: 10.1177/2042018815618177. PMID: 26885360; PMCID: PMC4740941.
- Holst JJ, Gasbjerg LS, Rosenkilde MM. The Role of Incretins on Insulin Function and Glucose Homeostasis. Endocrinology. 2021 Jul 1;162(7):bqab065. doi: 10.1210/endocr/bqab065. PMID: 33782700; PMCID: PMC8168943.
- Guner A, Cho M, Son T, Kim HI, Noh SH, Hyung WJ. Improved glycemic control with proximal intestinal bypass and weight loss following gastrectomy in non-obese diabetic gastric cancer patients. Oncotarget. 2017 Nov 1;8(61):104605-104614. doi: 10.18632/oncotarget.22262. PMID: 29262665; PMCID: PMC5732831.
- Sheng B, Truong K, Spitler H, Zhang L, Tong X, Chen L. The Long-Term Effects of Bariatric Surgery on Type 2 Diabetes Remission, Microvascular and Macrovascular Complications, and Mortality: a Systematic Review and Meta-Analysis. Obes Surg. 2017 Oct;27(10):2724-2732. doi: 10.1007/s11695-017-2866-4. PMID: 28801703.
- Koliaki C, Liatis S, le Roux CW, Kokkinos A. The role of bariatric surgery to treat diabetes: current challenges and perspectives. BMC Endocr Disord. 2017 Aug 10;17(1):50. doi: 10.1186/s12902-017-0202-6. PMID: 28797248; PMCID: PMC5553790.
- Vickers AJ, Altman DG. Statistics notes: Analysing controlled trials with baseline and follow up measurements. BMJ. 2001 Nov 10;323(7321):1123-4. doi: 10.1136/bmj.323.7321.1123. PMID: 11701584; PMCID: PMC1121605.
- Breiman L, Friedman JH, Olshen RA, Stone CJ. Classification and regression trees. New York: Routledge. 2017.
- Associação Brasileira para Estudo da Obesidade e da Síndrome Metabólica. Diretrizes brasileiras de obesidade. São Paulo: ABESO; 2016.
- Hershey DS. Importance of Glycemic Control in Cancer Patients with Diabetes: Treatment through End of Life. Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):313-318. doi: 10.4103/apjon.apjon_40_17. PMID: 28966959; PMCID: PMC5559941.
- Huh YJ, Son YG, Kim TH, Park JH, Oh TJ, Choi B, Min J, Cho YM, Yang HK, Lee HJ. Effect and Mechanisms of Diabetes Resolution According to the Range of Gastric Resection and the Length of Anastomosis in Animal Models: Implication for Gastric Cancer Surgery in Patients with Diabetes Mellitus. World J Surg. 2018 Apr;42(4):1056-1064. doi: 10.1007/s00268-017-4228-8. PMID: 28929278.
- Fernandes G. Avaliação do metabolismo glicêmico e perfil entero-hormonal no pós-operatório precoce em pacientes obesos graves diabéticos submetidos à gastroplastia em Y de Roux. Universidade de São Paulo; 2017.
- Pok EH, Lee WJ. Gastrointestinal metabolic surgery for the treatment of type 2 diabetes mellitus. World J Gastroenterol. 2014 Oct 21;20(39):14315-28. doi: 10.3748/wjg.v20.i39.14315. PMID: 25339819; PMCID: PMC4202361.
- Zilberstein B, Silveira-Filho AS, Ferreira JA, Carvalho MH, Bussons C, Joaquim H. Gastroplastia vertical com desvio jejunoileal: novo procedimento técnico. ABCD Arq Bras Cir Dig. 2014;27(3):199-201.
