Columbia University Center for Metabolic and Weight Loss Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York 10032, USA.
Surg Obes Relat Dis. 2010 May-Jun;6(3):249-53. doi: 10.1016/j.soard.2009.09.019. Epub 2009 Oct 29.
Studies have shown that type 2 diabetes (T2DM) improves or resolves shortly after Roux-en-Y gastric bypass (RYGB). Few data are available on T2DM recurrence or the effect of weight regain on T2DM status.
A review of 42 RYGB patients with T2DM and >or=3 years of follow-up and laboratory data was performed. Postoperative weight loss and T2DM status was assessed. Recurrence or worsening was defined as hemoglobin A1c >6.0% and fasting glucose >124 mg/dL and/or medication required after remission or improvement. Patients whose T2DM recurred or worsened were compared with those whose did not, and patients whose T2DM improved were compared with those whose T2DM resolved.
T2DM had either resolved or improved in all patients (64% and 36%, respectively); 24% (10) recurred or worsened. The patients with recurrence or worsening had had a lower preoperative body mass index than those without recurrence or worsening (47.9 versus 52.9 kg/m2; P = .05), regained a greater percentage of their lost weight (37.7% versus 15.4%; P = .002), had a greater weight loss failure rate (63% versus 14%; P = .03), and had greater postoperative glucose levels (138 versus 102 mg/dL; P = .0002). Patients who required insulin or oral medication before RYGB were more likely to experience improvement rather than resolution (92% versus 8%, P <or=.0001; and 85% versus 15%; P = .0006, respectively).
Our results have shown that beyond 3 years after RYGB, the incidence of T2DM recurrence or worsening in patients with initial resolution or improvement was significant. In our patients, a greater likelihood of recurrence or worsening of T2DM was associated with a lower preoperative body mass index. Before widespread acceptance of bariatric surgery as a definitive treatment for those with T2DM can be achieved, additional study of this recurrence phenomenon is indicated.
研究表明，2 型糖尿病（T2DM）在 Roux-en-Y 胃旁路术（RYGB）后不久即可改善或缓解。关于 T2DM 的复发或体重反弹对 T2DM 状态的影响，数据有限。
对 42 例 T2DM 且随访时间>3 年的 RYGB 患者进行了回顾性分析，并进行了实验室数据评估。术后体重减轻和 T2DM 状态进行了评估。复发或恶化定义为血红蛋白 A1c>6.0%、空腹血糖>124mg/dL 和/或缓解或改善后需要药物治疗。比较 T2DM 复发或恶化患者与未复发或恶化患者，以及 T2DM 改善患者与 T2DM 缓解患者。
所有患者的 T2DM 均得到缓解或改善（分别为 64%和 36%）；24%（10 例）复发或恶化。复发或恶化患者的术前体重指数低于未复发或恶化患者（47.9 与 52.9kg/m2；P=0.05），体重反弹百分比更大（37.7%与 15.4%；P=0.002），体重减轻失败率更高（63%与 14%；P=0.03），术后血糖水平更高（138 与 102mg/dL；P=0.0002）。RYGB 术前需要胰岛素或口服药物的患者更有可能改善而非缓解（92%与 8%，P<0.0001；85%与 15%，P=0.0006）。
我们的结果表明，在 RYGB 术后 3 年以上，初始缓解或改善的患者 T2DM 复发或恶化的发生率显著。在我们的患者中，T2DM 复发或恶化的可能性更大与术前体重指数较低有关。在接受减重手术作为 T2DM 患者的明确治疗方法得到广泛认可之前，需要进一步研究这种复发现象。
