Department of Endocrinology, Medwin Hospitals, Nampally, Andhra Pradesh, India.
Diabetes Technol Ther. 2009 Dec;11(12):785-9. doi: 10.1089/dia.2009.0070.
Bariatric surgery offers the best solution in management of obesity and related metabolic ailments, paving the way for a concept termed metabolic surgery. We report the results of a novel surgical procedure on glycemic control and metabolic syndrome in poorly controlled type 2 diabetes.
Ten patients (four men, six women) underwent laparoscopic surgical procedure of sleeve gastrectomy and ileal interposition. All patients had diabetes for more than 3 years with poor control despite use of oral hypoglycemic agents (OHAs) and/or insulin. The primary outcome was remission of diabetes (hemoglobin A1c <7% without OHAs/insulin), and secondary outcomes were change in OHA requirement, components of metabolic syndrome, insulin resistance, and microalbuminuria.
We report the preliminary postoperative follow-up data of 9.1 +/- 5.3 months (range, 2-16 months). Participants had a mean age of 48.2 +/- 9 years (range, 34-62 years), duration of diabetes of 11 +/- 5.7 years (range, 4-25 years), and preoperative body mass index of 33.8 +/- 6.5 kg/m(2). Seven patients had diabetes remission, and the remaining three showed significantly decreased OHA requirement. All participants had weight loss ranging between 15% and 30% and had remission of hypertension. Microalbuminuria (96.8 +/- 19.1 vs. 46.7 +/- 10.1 mg/L, P = 0.03568) and insulin resistance as assessed by homeostasis assessment model of insulin resistance (5.2 +/- 2.1 vs. 1.8 +/- 0.9, P = 0.0005) decreased significantly after surgery.
Our preliminary observations demonstrated the feasibility, safety, and efficacy of this novel surgical procedure in type 2 diabetes. Further long-term data from more patients are necessary to confirm these findings.
减重手术是肥胖及其相关代谢疾病的最佳治疗方法，为代谢手术概念铺平了道路。我们报告了一种新型手术治疗方法对血糖控制和代谢综合征的影响，这些患者患有控制不佳的 2 型糖尿病。
10 例患者（4 名男性，6 名女性）接受了腹腔镜袖状胃切除术和回肠旁路术。所有患者均患有糖尿病 3 年以上，尽管使用了口服降糖药（OHA）和/或胰岛素，但血糖控制仍不佳。主要结果是糖尿病缓解（糖化血红蛋白<7%，无需 OHA/胰岛素），次要结果是 OHA 需求的变化、代谢综合征的组成部分、胰岛素抵抗和微量白蛋白尿的变化。
我们报告了 9.1 ± 5.3 个月（范围，2-16 个月）的初步术后随访数据。参与者的平均年龄为 48.2 ± 9 岁（范围，34-62 岁），糖尿病病程为 11 ± 5.7 年（范围，4-25 年），术前体重指数为 33.8 ± 6.5 kg/m²。7 例患者糖尿病缓解，其余 3 例 OHA 需求明显减少。所有患者的体重减轻在 15%-30%之间，且高血压缓解。微量白蛋白尿（96.8 ± 19.1 比 46.7 ± 10.1 mg/L，P = 0.03568）和胰岛素抵抗（稳态模型评估的胰岛素抵抗，5.2 ± 2.1 比 1.8 ± 0.9，P = 0.0005）术后明显降低。
我们的初步观察结果表明，这种新型手术治疗方法在 2 型糖尿病中具有可行性、安全性和有效性。需要更多患者的长期数据来证实这些发现。
