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Case report

Gastrojejunostomy resolves T2DM in BMI<35 patient

Beneficial side-effect of operation leads surgeons to call for reconsidered diabetic surgery guidelines
The patient underwent a vagotomy, pictured, a subtotal gastrectomy, and a Roux-en-Y gastrojejunostomy for gastric ulcers.

A diabetic patient with a BMI of 34.6 experienced a full resolution of her type 2 diabetes symptoms after being given a laparoscopic truncal vagotomy, subtotal gastrectomy, and Roux-en-Y gastrojejunostomy to treat her gastric ulcers, according to a new case report published in Case Reports in Surgery.

The case led the patient’s surgeons to call for the US’ National Institutes for Health to reconsider their guidelines for the use of Roux-en-Y gastric bypass in treating uncontrolled type 2 diabetes, which stipulate that it should only be considered in patients with a BMI over 35.

The patient was a 48-year-old Caucasian woman with intractable gastric and duodenal ulcers; she had a history of type 2 diabetes, hypertension, hypercholesterolemai, gastritis, esophagitis, and gastroparesis.

To treat her diabetes, she took Lantus 30U once a day, Januvia 100mg once a day, and Metformin 1000mg twice a day.

To treat her ulcers, she underwent a laparoscopic truncal vagotomy, subtotal gastrectomy, and a Roux-en-Y gastrojejunostomy, which succeeded with no complications.

Three months before her operation, her HbA1c was 7.9%, and her fasting glucose was 147mg/dL. Ten days after her operation, her HbA1c was measured at 7.2%, and her glucose was 97mg/dL; at three months, they were at 6.5% and 105mg/dL respectively.

From 10 days after her surgery onwards, the patient had no need of insulin or oral medications for blood sugar control.

The patient’s diabetic factors continued to improve through two years of follow-up, when her HbA1c was 5.9%, her fasting glucose was 80mg/dL and her BMI had dropped to 22.3.

In the conclusion of their case study, the authors say that patients with uncontrolled type 2 diabetes with BMIs under 35 should be considered for Roux-en-Y gastric bypass, and that more studies should be conducted to test the efficacy of the operation to treat diabetes in less-obese patients.

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