Department of Surgery, Regional Hospital of Vicenza, Vicenza, Italy.
Surg Obes Relat Dis. 2010 Mar 4;6(2):132-7. doi: 10.1016/j.soard.2009.09.014. Epub 2009 Oct 3.
Interest in bariatric surgery is growing as an effective method for long-term metabolic control in morbidly obese patients with type 2 diabetes. We analyzed the weight loss and changes in use of diabetic medication in obese patients with type 2 diabetes treated with laparoscopic adjustable gastric banding (LAGB).
From 1993 to 2005, 1791 morbid obese patients underwent LAGB at our institution. Of the 1791 patients, 394 (22%) had type 2 diabetes mellitus at baseline. Of the 394 patients with diabetes, 52 were receiving diabetic medication. The median follow-up period for the drug-treated diabetic patients was 3 years (range .25-9).
The drug-treated diabetic patients were older (age 47.6 +/- 7.5 versus 37.5 +/- 10.7 years, P <.001), weighed more (body mass index 49.1 +/- 9.5 versus 45.6 +/- 7.5 kg/m(2), P 0.001), and were more frequently affected by co-morbidities than the nondiabetic patients at surgery. The percentage of excess weight loss 1 year after surgery was less (32.4% +/- 14.1% versus 41.1% +/- 19.9%, P <.01) for the drug-treated diabetic patients than for the nondiabetic patients. This difference was maintained for 5 years of follow-up. A significant decline occurred in the use of both oral diabetic medication and insulin after surgery. Of the 52 patients treated with oral antidiabetic medication at baseline, 33 required oral antidiabetic medication at the end of follow-up. Of the 6 patients who also required insulin at baseline, 2 did so at the end of follow-up. The use of diabetic medication had increased in 4 patients (7.7%), was unchanged in 12 (23.1%), had decreased in 17 (32.7%), and was suspended in 19 (36.5%) of 52 patients.
The amount of weight loss after LAGB was less in drug-treated diabetic patients than in nondiabetic patients. However, LAGB was associated with a sustained reduction in the use of diabetic medication.
作为肥胖伴有 2 型糖尿病患者长期代谢控制的有效方法，减重手术的兴趣日益增加。我们分析了腹腔镜可调胃束带术（LAGB）治疗肥胖伴有 2 型糖尿病患者的体重减轻和糖尿病药物使用变化。
1993 年至 2005 年，我院对 1791 例病态肥胖患者进行了 LAGB。在 1791 例患者中，基线时有 394 例（22%）患有 2 型糖尿病。在 394 例糖尿病患者中，52 例正在服用糖尿病药物。接受药物治疗的糖尿病患者的中位随访时间为 3 年（范围 25-9 年）。
接受药物治疗的糖尿病患者年龄较大（年龄 47.6 ± 7.5 岁比 37.5 ± 10.7 岁，P <.001），体重更重（体重指数 49.1 ± 9.5 千克/米 2 比 45.6 ± 7.5 千克/米 2 ，P <.001），并且在手术时比非糖尿病患者更常患有合并症。术后 1 年时，体重减轻的百分比较低（32.4% ± 14.1%比 41.1% ± 19.9%，P <.01）。这种差异在 5 年的随访中保持不变。术后，口服糖尿病药物和胰岛素的使用均显著下降。在基线时接受口服抗糖尿病药物治疗的 52 例患者中，有 33 例在随访结束时需要口服抗糖尿病药物。在基线时还需要胰岛素的 6 例患者中，有 2 例在随访结束时需要胰岛素。在 52 例患者中，有 4 例（7.7%）的糖尿病药物使用增加，12 例（23.1%）不变，17 例（32.7%）减少，19 例（36.5%）停药。
与非糖尿病患者相比，LAGB 后药物治疗的糖尿病患者体重减轻幅度较小。然而，LAGB 与持续减少糖尿病药物的使用有关。
