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Dynamics of glucose levels after Billroth I versus Roux-en-Y reconstruction in patients who undergo distal gastrectomy

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Abstract

Purpose

Recent studies have highlighted the importance of understanding trends in blood glucose levels. We examined the differences in blood glucose fluctuations according to the reconstruction method used after distal gastrectomy (DG) in patients with non-diabetic gastric cancer (GC).

Methods

Sixty-one patients who underwent DG followed by either Billroth 1 (B1) or Roux-en-Y (R-Y) reconstruction were enrolled in this study. We used flash continuous glucose monitoring (CGM), a new technique for assessing glycemic control, to document the post-gastrectomy glycemic profile. Immediately before discharge, a CGM sensor was placed subcutaneously to evaluate blood glucose trends for 2 weeks.

Results

The coefficient of variation of glucose levels was significantly higher in the Roux-en-Y (R-Y) group than in the Billroth I (B-I) group (p = 0.0260). The time below range (TBR, glucose levels of < 70 mg/dL) was also significantly higher in the R-Y group (p = 0.0115). Logistic regression analysis revealed that preoperative casual glucose levels of < 100 mg/dL and R-Y reconstruction were independently correlated with risk factors for a postoperative nocturnal TBR of > 30% (p = 0.006 and 0.042, respectively).

Conclusion

Our findings provide new insights into the post-DG reconstruction method selected for patients with non-diabetic gastric cancer by assessing postoperative blood glucose fluctuations using flash CGM.

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Acknowledgements

This work was partially supported by JSPS KAKENHI (Grant Number 18K16324). All authors contributed to the final manuscript.

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Authors and Affiliations

  1. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 6028566, Japan

    Katsutoshi Shoda, Takeshi Kubota, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Kazuma Okamoto & Eigo Otsuji

  2. First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan

    Katsutoshi Shoda, Yoshihiko Kawaguchi, Hidenori Akaike & Daisuke Ichikawa

  3. Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 6028566, Japan

    Emi Ushigome & Michiaki Fukui

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  1. Katsutoshi Shoda
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  2. Takeshi Kubota
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  3. Emi Ushigome
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  4. Hirotaka Konishi
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Contributions

Conceptualization: KS and TK; Methodology: KS, TK, EU, and MF; Formal analysis and investigation: KS, HK, AS, and HF; Writing—original draft preparation: KS; Writing—review and editing: TK and DI; Supervision: EO.

Corresponding authors

Correspondence to Katsutoshi Shoda or Takeshi Kubota.

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Conflict of interest

We have no conflicts of interest to disclose.

Ethical standards

This study conformed to the ethical guidelines of the World Medical Association Declaration of Helsinki. All the patients provided written informed consent for surgery and the use of their clinical data, as required by the Institutional Review Board of the Kyoto Prefectural University of Medicine (ERB-C-975-2).

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Shoda, K., Kubota, T., Ushigome, E. et al. Dynamics of glucose levels after Billroth I versus Roux-en-Y reconstruction in patients who undergo distal gastrectomy. Surg Today 52, 889–895 (2022). https://doi.org/10.1007/s00595-021-02404-4

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  • DOI: https://doi.org/10.1007/s00595-021-02404-4

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