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

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...

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Published in:World journal of gastroenterology : WJG 2015-01, Vol.21 (4), p.1173-1181
Main Authors: Lee, Eun Kyung, Kim, So Young, Lee, You Jin, Kwak, Mi Hyang, Kim, Hak Jin, Choi, Il Ju, Cho, Soo-Jeong, Kim, Young Woo, Lee, Jong Yeul, Kim, Chan Gyoo, Yoon, Hong Man, Eom, Bang Wool, Kong, Sun-Young, Yoo, Min Kyong, Park, Jong Hyock, Ryu, Keun Won
Format: Article
Language:English
Subjects:
Aged
Antihypertensive Agents - therapeutic use
Biomarkers - blood
Blood Glucose - drug effects
Blood Glucose - metabolism
Blood Pressure - drug effects
cancer
N
Chi-Square Distribution
Diabetes Mellitus - blood
Diabetes Mellitus - diagnosis
Diabetes Mellitus - drug therapy
Diabetes Mellitus - mortality
Diabetes
Hypertension
Gastrectomy
Gastric
Drug Therapy, Combination
Female
Gastrectomy - adverse effects
Gastrectomy - methods
Gastrectomy - mortality
Gastroscopy
Humans
Hypertension - diagnosis
Hypertension - drug therapy
Hypertension - mortality
Hypertension - physiopathology
Hypoglycemic Agents - therapeutic use
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Recovery of Function
Republic of Korea - epidemiology
Retrospective Cohort Study
Retrospective Studies
Stomach Neoplasms - diagnosis
Stomach Neoplasms - mortality
Stomach Neoplasms - surgery
Time Factors
Treatment Outcome
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Summary: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 antidiabetic 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 theimprovement 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.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v21.i4.1173