Morbid Obesity Center, Vestfold Hospital Trust, Post box 2168, 3103, Tønsberg, Norway.
Obes Surg. 2010 Mar;20(3):302-7. doi: 10.1007/s11695-009-0022-5. Epub 2009 Dec 1.
Higher mortality rates among morbidly obese (BMI of > or =40 or > or =35 kg/m2 with weight-related comorbidities) subjects are mainly explained by comorbidities such as type 2 diabetes. As bariatric surgery ameliorates diabetes, obese diabetic subjects will receive great benefits from bariatric surgery. Screening for diabetes prior to surgical referral is therefore crucial.
We studied 1,253 consecutively recruited (2005-2008) morbidly obese subjects (67% women). Among subjects without known diabetes, 70% (670/961) performed an oral glucose tolerance test (OGTT). Screen-detected diabetes was defined as fasting plasma glucose (fPG) > or =7.0 mmol/l and/or 2-h glucose concentration (2hPG) > or = 11.1 mmol/l.
Within the study population, 31% had diabetes, of which 8% were screen-detected. Eighty percent of those with screen-detected diabetes were diagnosed by fPG. In subjects with nondiabetic fPG concentrations, elevating the fPG cutoff value from 5.2 mmol/l to the World Health Organization's (WHO's) recommended value of 6.1 mmol/l reduced the percentage of the population needing an OGTT considerably (78-23%), but only slightly reduced the sensitivity of fPG in detecting a diabetic 2hPG concentration (100-77%). Only 7% of the patients with fPG between 6.1 and 6.9 mmol/l had a diabetic 2hPG concentration. Following the WHO's recommendations, we found that 95% of all subjects with unknown diabetes were identified.
Fasting glucose identified four out of five morbidly obese subjects with unknown diabetes. A supplemental OGTT in selected persons identified the majority of the remaining diabetic cases.
病态肥胖（BMI>或=40 或>或=35kg/m2 伴与体重相关的合并症）患者的死亡率较高，主要是由于合并症如 2 型糖尿病引起的。由于减重手术可改善糖尿病，肥胖的糖尿病患者将从减重手术中获益匪浅。因此，在转介手术前对糖尿病进行筛查至关重要。
我们研究了连续招募的 1253 例病态肥胖患者（67%为女性）（2005-2008 年）。在无已知糖尿病的患者中，70%（670/961）进行了口服葡萄糖耐量试验（OGTT）。筛检发现的糖尿病定义为空腹血糖（fPG）>或=7.0mmol/l 和/或 2 小时血糖浓度（2hPG）>或=11.1mmol/l。
在研究人群中，31%患有糖尿病，其中 8%为筛检发现。80%筛检发现的糖尿病患者通过 fPG 诊断。在 fPG 浓度正常的非糖尿病患者中，将 fPG 截断值从 5.2mmol/l 提高到世界卫生组织（WHO）推荐的 6.1mmol/l，大大降低了需要进行 OGTT 的人群比例（78%-23%），但 fPG 检测糖尿病 2hPG 浓度的敏感性仅略有降低（100%-77%）。只有 7%的 fPG 在 6.1 至 6.9mmol/l 之间的患者有糖尿病 2hPG 浓度。根据 WHO 的建议，我们发现 95%的未知糖尿病患者都得到了识别。
空腹血糖可确定五分之四的未知糖尿病病态肥胖患者。在选定的人群中进行补充 OGTT 可识别大多数剩余的糖尿病病例。
