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Page 8 of 12 Yang et al. Mini-invasive Surg 2021;5:11 I http://dx.doi.org/10.20517/2574-1225.2021.06

Table 4. Univariable analysis of preoperative and postoperative factors in patients with and without T2DM remission
Remission † No remission
Factor P
(n = 14) (n = 57)
Age (years) 37.8 ± 8.4 47.2 ± 9.8 0.002
Weight (kg) 109.3 ± 36.1 86.2 ± 19.8 0.035
2
BMI (kg/m ) 36.3 ± 10.1 30.5 ± 6.9 0.013
Waist circumference (cm) 115.6 ± 25.7 102.8 ± 16.6 0.184
Fasting blood glucose (mg/dL) 188.4 ± 77.9 163.8 ± 63.5 0.218
HbA1c (%) 8.6 ± 2.2 7.8 ± 1.9 0.197
Duration of T2DM (years) 3.1 ± 3.6 6.2 ± 4.9 0.030
Number of T2DM medications 1.8 ± 1.9 2.4 ± 1.4 0.249
Weight change (kg) -25.0 ± 13.2 -18.2 ± 17.2 0.295
Percent weight change (%) -26.4 ± 10.5 -18.6 ± 13.1 0.123
2
BMI change (kg/m ) -8.4 ± 4.6 -6.6 ± 6.3 0.435
Data are shown as mean ± standard deviation. Results are consistent with the results of multivariable logistic regression, although the
sample size was too small to support formal statistical modeling robustly. †Remission was defined as fasting blood glucose < 110 mg/dL,
HbA1c < 6.0%, and without the use of anti-hyperglycemic agents at 12 months after surgery. BMI: Body mass index; HbA1c: glycosylated
hemoglobin; T2DM: type 2 diabetes mellitus.

DISCUSSION
This study showed that RYGB may be effective for weight loss and control of T2DM in Chinese patients
who are obese and overweight considering the low remission rate. Patients with T2DM who were younger,
had a higher BMI at baseline, and had a shorter T2DM duration were more likely to achieve T2DM
remission. In patients with T2DM, significant improvements in anthropometric characteristics were
observed at 12 months after surgery. Significant and meaningful improvements were concurrently observed
in glycemic and lipid measurements. The outcomes reported in this retrospective study for RYGB appear
[11]
consistent with recently published literature seen in Western patients with T2DM and Asian patients
[15]
with T2DM .
Nevertheless, a major difference should be noted. In Western countries, about 80% of the patients who
undergo bariatric surgery are female, mainly because of greater worries about the physical appearance
[16]
and higher awareness of the impact of overweight on health than men . In the present study, most patients
were male (65%). In the study of the bariatric surgeries performed between 2001 and 2015 in China, Du et al. [5]
reported that males represented 48% of the patients, significantly more than in Western countries. The exact
[5]
reason for this discrepancy is difficult to explain, as highlighted by Du et al. , and additional study is
necessary.

The WHO has previously presented health action points for BMI categories in Asian populations. The
2
2
suggested categories were: underweight, < 18.5 kg/m ; increasing but acceptable risk, 18.5-23 kg/m ;

2
2[4]
increased risk, 23-27.5 kg/m ; and high-risk, ≥ 27.5 kg/m . The Diabetes Surgery Summit II (DSS-II)
concluded that there is sufficient clinical and mechanistic evidence to support the inclusion of metabolic
surgery among antidiabetic interventions for patients with T2DM and obesity, and it should be considered
2
for Asian patients with T2DM and BMI 27.5-32.4 kg/m if hyperglycemia is inadequately controlled with
[17]
either oral or injectable medications . In this study, we found that there was a redistribution of the BMI
2
groups at 12 months after RYGB. In patients in the high-risk category (≥ 27.5 kg/m ) at baseline, risk was
reduced by one or more categories in ≥ 70% of patients, and, among those in the increased risk category
2
(23.0 to < 27.5 kg/m ) at baseline, over 50% reached the increasing but acceptable risk category (18.5 to <
2
23.0 kg/m ). This result is consistent with the conclusions made by the DSS-II.
In the present study, the T2DM remission rate at 12 months was 19.7%, which is lower than that reported
in the Swedish Obese Subject study, where the remission rate with surgery was 72.3% at two years, but it
[18]
[19]
decreased to 30.4% at 15 years . A meta-analysis reported a remission rate of 78.1% . The exact criteria