Effect of different alimentary reconstruction after radical surgery for gastric cancer on blood glucose in patients with type 2 diabetes mellitus

Objective To explore the effect of alimentary tract reconstruction after gastrectomy on blood glucose in patients with gastric cancer complicated with type 2 diabetes mellitus(T2DM). Methods The clinical data was retrospectively analyzed in 66 cases who received radical surgery for gastric cancer with T2DM from January 2008 to January 2012 in Changhai Hospital. These patients were divided into two groups according to different types of digestive tract reconstruction: Billroth Ⅰ(n=26, group A) and Billroth Ⅱ(n=40, group B). The preoperative clinical features, including the age, course of T2DM, body mass index(BMI), glycated hemoglobin A1c(HbA1c), insulin dosage, fasting plasma glucose (FPG) and 2-hour postprandial plasma glucose(2 h PG), were observed and compared between the two groups. And on the time of one week and three months after surgery, the FPG, 2 h PG were compared between the both two groups. The data were compared by using analysis of variance. Results There was no statistical difference in FPG and 2 h PG before and after operation in group A (both P>0.05). The FPG and 2 h PG in group B decreased significantly one week and three months after operation when compared with those before operation (FPG: (7.0±0.6) vs (6.1±0.4) vs (10.2±1.0) mmol/L, F=4.25, P<0.05; 2 h PG: (8.8±0.1) vs (7.3±1.1) vs (11.4±1.8) mmol/L, F=3.87, P<0.05). Moreover, the FPG and 2 h PG in group B were all significantly lower than those in group B one week and three months after the operation (FPG at one week after surgery (7.0±0.6) vs(10.0±0.7) mmol/L , t=5.35, P<0.05, and three months after operation (6.1±0.4) vs (9.8±0.7) mmol/L, t=4.78, P<0.05; 2 h PG at one week after surgery (8.8±0.1) vs (12.3±0.5) mmol/L, t=6.12, P<0.05, and three months after operation (7.3±1.1) vs (11.7±0.6) mmol/L, t=6.78, P<0.05). Conclusion The Billroth Ⅱ anastomosis reconstruction for distal gastrectomy brings remarkable effects on hyperglycemia in patients with gastric cancer and T2DM. Key words: Diabetes mellitus, type 2; Stomach neoplasms; Gastrectomy; Digestive tract reconstruction