Improvement of diabetes and hypertension after gastrectomy: A nationwide cohort study

doi:10.3748/wjg.v21.i4.1173

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. Jan 28, 2015; 21(4): 1173-1181
Published online Jan 28, 2015. doi: 10.3748/wjg.v21.i4.1173

Improvement of diabetes and hypertension after gastrectomy: A nationwide cohort study

Eun Kyung Lee, So Young Kim, You Jin Lee, Mi Hyang Kwak, Hak Jin Kim, Il Ju Choi, Soo-Jeong Cho, Young Woo Kim, Jong Yeul Lee, Chan Gyoo Kim, Hong Man Yoon, Bang Wool Eom, Sun-Young Kong, Min Kyong Yoo, Jong Hyock Park, Keun Won Ryu

Eun Kyung Lee, You Jin Lee, Mi Hyang Kwak, Hak Jin Kim, Il Ju Choi, Soo-Jeong Cho, Jong Yeul Lee, Chan Gyoo Kim, Department of Internal Medicine, National Cancer Center, Goyang 410-769, South Korea

So Young Kim, Jong Hyock Park, College of Medicine/Graduate, School of Health Science, Business Convergence, Chungbuk National University, Cheongju 361-763, South Korea

Young Woo Kim, Hong Man Yoon, Bang Wool Eom, Keun Won Ryu, Department of Surgery, National Cancer Center, Goyang 410-769, South Korea

Sun-Young Kong, Department of Laboratory Medicine, National Cancer Center, Goyang 410-769, South Korea

Min Kyong Yoo, Department of Clinical Nutrition, National Cancer Center, Goyang 410-769, South Korea

Author contributions: Lee EK and Kim SY contributed equally to this work; Kim YW, Ryu KW, Park JH and Choi IJ contributed to the study concept and design; Kim SY and Park JH contributed to the acquisition of data; Kim SY and Lee EK contributed to the analysis and interpretation of data; Lee EK, Kong SY and Eom BW contributed to the drafting of the manuscript; Choi IJ, Cho SJ, Lee YJ, Kim HJ, Yoo MK, Lee JY, Kim CG, Yoon HM and Kwak MH contributed to the critical revision of the manuscript for important intellectual content.

Supported by A research grant from the National Cancer Center, No. 1210552-1,2.

Correspondence to: Jong Hyock Park, MD, PhD, College of Medicine/Graduate, School of Health Science, Business Convergence, Chungbuk National University, 12 Gaesin-dong, Heungdeok-gu, Cheongju-si, Cheongju 361-763, South Korea. jonghyock@gmail.com

Telephone: +82-43-2612873 Fax: +82-43-2697902

Received: April 30, 2014
Peer-review started: May 2, 2014
First decision: June 10, 2014
Revised: July 23, 2014
Accepted: September 12, 2014
Article in press: September 16, 2014
Published online: January 28, 2015
Processing time: 271 Days and 20 Hours

Abstract

AIM: To evaluate the effect of gastrectomy on diabetes mellitus (DM) and hypertension (HTN) in non-obese gastric cancer patients.

METHODS: A total of 100000 patients, diagnosed with either type 2 DM or HTN, were randomly selected from the 2004 Korean National Health Insurance System claims. Among them, 360 diabetes and 351 hypertensive patients with gastric cancer who had been regularly treated without chemotherapy from January 2005 to December 2010 were selected. They were divided into three groups according to their treatment methods: total gastrectomy (TG), subtotal gastrectomy (STG) and endoscopic resection (ER).

RESULTS: The drug discontinuation rate of anti-diabetic and anti-hypertensive agents after gastric cancer treatment was 9.7% and 11.1% respectively. DM appeared to be improved more frequently (22.8%) and earlier (mean ± SE 28.6 ± 1.8 mo) in TG group than in the two other groups [improved in 9.5% of ER group (37.4 ± 1.1 mo) and 6.4% of STG group (47.0 ± 0.8 mo)]. The proportion of patients treated with multiple drugs decreased more notably in TG group compared to others (P = 0.001 in DM, and P = 0.035 in HTN). In TG group, adjusted hazard ratio for the improvement of DM was 2.87 (95%CI: 1.15-7.17) in a multi-variate analysis and better control of DM was observed with survival analysis (P < 0.001).

CONCLUSION: TG was found to decrease the need for anti-diabetic medications which can be reflective of improved glycemic control, to a greater extent than either ER or STG in non-obese diabetic patients.

Keywords: Diabetes; Hypertension; Gastrectomy; Gastric cancer; National cohort

Core tip: By following the long term outcome of diabetes and hypertension after gastrectomy, we have discovered that total gastrectomy has a profound impact on the improvement of both diabetes and hypertension compared with endoscopic resection in non-obese population.