Duodenal Exclusion in the Regulation of Glycemia in Type 2 Diabetic Patients Submitted to Gastrectomy with Roux-en-Y by Gastric Cancer: Cohort Study

Obesity has become a global epidemic in the 21st century with Type 2 Diabetes Mellitus (T2DM) being century, with Type 2 Diabetes Mellitus (T2DM) being one of its most serious and costly consequences [1]. In 2019, an international consensus recognized In 2019, an international consensus recognized metabolic and bariatric surgery as a viable long-term treatment for T2DM. Procedures such as Rouxen-Y gastric bypass (RYGB) have demonstrated effectiveness in improving glycemic control, suggesting suggesting mechanisms beyond mere weight loss [2 mechanisms beyond mere weight loss [2- 4]. 

Studies have proposed that enhanced glycemic regulation may result from increased secretion of regulation may result from increased secretion of incretins in the distal intestine, stimulated by the accelerated transit of nutrients through this region accelerated transit of nutrients through this region [5,6]. Alternatively, some authors have hypothesized that exclusion of the proximal intestine plays a critical role in diabetes improvement [7]. A 2017 metaanalysis concluded that surgical interventions for T2DM yield superior remission rates and reduced risks of microvascular and macrovascular complications, as well as lower mortality, compared to non-surgical treatments [8]. Patients undergoing gastrointestinal surgery for conditions unrelated to obesity represent an important model for examining the isolated impact of duodenal exclusion on T2DM outcomes [9,10]. Accordingly, the aim of this study was to evaluate changes in glycemic control in diabetic patients who changes in glycemic control in diabetic patients who underwent total or subtotal gastrectomy with Rouxen-Y reconstruction for gastric cancer.