Sarcouncil Journal of Medicine and Surgery

Abstract: Background: Roux-en-Y gastric bypass (RYGB) has been shown to induce rapid, weight-independent remission of type 2 diabetes mellitus (T2DM) in a significant percentage of patients. The foregut hypothesis suggests that the key to this antidiabetic effect is the exclusion of the proximal small intestine of nutrient transit as well as Purpose was to assess the association between proximal small intestinal bypass-related metabolic and hormonal alterations and glycemic remission in patients with T2DM who received RYGB, where 115 patients with T2DM who had undergone RYGB at least 12 months ago were studied in a cross-sectional study. Demographic information, anthropometric data, glycemic (HbA1c, fasting plasma glucose, fasting insulin, C-peptide, HOMA-IR), and gut hormones (GLP-1, GIP, ghrelin, PYY) were measured. Descriptive statistics, Pearson correlation, paired t-tests, and multivariate logistic regression were used to analyze data. A p-value less than 0.05 was deemed statistically significant and finding were of 115 patients (mean age 47.8 ± 9.6 years; 68.7% female; mean preoperative BMI 43.2 ± 5.8 kg/m²), complete diabetes remission (HbA1c < 6.0% without medication) was achieved in 68 patients (59.1%) and partial remission in 21 (18.3%) in addition to found Mean HbA1c decreased from 8.4 ± 1.3% preoperatively to 5.9 ± 0.9% postoperatively (p < 0.001) while found Postprandial GLP-1 rose by 312% (p < 0.001), while GIP declined by 28% (p = 0.002) where In multivariate logistic regression, the shorter the duration of diabetes (OR 0.82; 95% CI 0.730.92; p<|human|>In multivariate logistic regression, the less duration of diabetes (OR 0.82; 95% CI 0.730.92; p<|human|>In multivariate= 0.001), lower preoperative HbA1c (OR 0.58; 95% CI 0.40–0.84; p = 0.004), and higher postoperative GLP- 1 response (OR 2.41; 95% CI 1.52–3.82; p < 0.001) independently predicted diabetes remission furthermore at conclousion Removal of the proximal small intestine after RYGB is linked with significant improvement of GLP-1 release, inhibition of GIP action, and decreased insulin resistance - which is consistent with the foregut hypothesis as the key mechanism in T2DM remission regardless of weight loss.