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Page 2 of 12 Yang et al. Mini-invasive Surg 2021;5:11 I http://dx.doi.org/10.20517/2574-1225.2021.06

surgery. The STROCSS guideline checklist was applied.

Results: In total, 130 patients underwent RYGB: 85 males and 45 females; age, 43.4 ± 11.3 years; and preoperative
2
body mass index (BMI), 33.1 ± 9.0 kg/m . Of those, 103 (79.2%) had T2DM duration of 6.6 ± 4.7 years and pre-
RYGB HbA1c of 8.1 ± 1.9%. Among the patients with T2DM, glycemic control (HbA1c < 7.0%) increased from
28.7% before surgery to 79.3% at 12 months post-procedure, with a concurrent reduction in the use of anti-
hyperglycemic agents, including a reduction in insulin requirement from 55.4% to 27.0%. The percentage of
excess weight loss was -42.8 ± 44.2%. Among 71 patients with T2DM and data about remission status, 14
(19.7%) achieved T2DM remission at 12 months post-surgery. Age and duration of T2DM were lower in the
remission group, while baseline BMI and weight were higher compared with the non-remission group.

Conclusion: RYGB may be effective for weight loss and T2DM control in Chinese patients, and outcomes are
consistent with the literature in Western populations. Younger patients with T2DM and with a higher BMI pre-
surgery and shorter duration of T2DM were more likely to achieve T2DM remission.

Keywords: Type 2 diabetes, obesity, roux-en-Y gastric bypass, glycemic control, remission

INTRODUCTION
World Health Organization (WHO) estimates that 422 million adults globally were living with type 2
[1]
diabetes mellitus (T2DM) in 2014 and that the prevalence of T2DM has doubled since 1980 . China
has almost 115 million patients with T2DM, with an adult diabetes prevalence of 9.8% that is rapidly
increasing, presenting in individuals with higher insulin resistance but with lower body mass index (BMI)
[2-4]
and approximately 10 years younger than their Western counterparts . A review of the literature about
bariatric surgery in China showed a significant increase in the number of procedures performed in China
between 2001 and 2015 (a total of 7779 procedures in this period, from 47 surgeries during 2001-2005 to
795 during 2006-2010 and 6937 during 2011-2015); in addition, the proportion of procedures performed to
treat obesity-related comorbidities (defined as metabolic surgery) increased from 0% of the total number of
procedures performed in 2001 to 70% by 2015 .
[5]
[6]
While the growing obesity pandemic is considered a major factor in the growth of T2DM prevalence ,
[7]
central adiposity, not BMI per se, is considered a primary factor in the rise of T2DM in China and other
regions of Asia . BMI distributions in the adult populations differ between the United States and China.
[8]
[9]
2
Approximately 31% of adults in China are classified as overweight (BMI ≥ 24 to < 28.0 kg/m ) and 12%
2
2
as obese (BMI ≥ 28 kg/m ) compared to 40% obese (BMI ≥ 30.0 kg/m ) and 8% severely obese (BMI ≥ 40.0
[10]
2
kg/m ) in the United States in 2016 . Therefore, the WHO has defined obesity in terms of abdominal
obesity, a waist-hip ratio above 0.90 for males and 0.85 for females, or a BMI > 30.0 kg/m 2[6,11] and has
2
recommended health action (such as bariatric surgery) in Asians with T2DM at a BMI 2.5 kg/m lower
than in other ethnicities (i.e, BMI 27.5 kg/m vs. 30.0 kg/m ). Globally, bariatric metabolic surgeries such as
2
2
Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy have emerged as the most effective interventions
[11]
for sustained weight and diabetes control in patients who are obese . Given the burden of disease in
China, metabolic surgery is being undertaken in some patients at even lower BMI [12,13] . Studies showed that
laparoscopic RYGB could be beneficial in patients with BMI < 28 kg/m , or even < 27.5 kg/m 2[12,13] .
2
Although the surgical techniques have been described extensively, evidence of laparoscopic RYGB in
Chinese patients who are overweight or obese, with or without T2DM, is still limited. This multicenter
study aimed to examine the health outcomes after RYGB surgery and determine the potential preoperative
predictors of diabetes remission after RYGB surgery.