Department of Surgery, University of Genoa, Italy.
Ann Surg. 2011 Apr;253(4):699-703. doi: 10.1097/SLA.0b013e318203ae44.
Biliopancreatic diversion (BPD) resolves type 2 diabetes in near totality of morbidly obeses [BMI (body mass index) ≥35 kg/m]. However, studies of BPD effect in BMI range 25.0 to 34.9 kg/m, including about 90% of diabetic patients, are lacking.
If BPD effects are independent of weight changes, they should be maintained in patients who, being mildly obese or overweight, will lose little or no weight after operation. Thirty type 2 diabetic patients with BMI 25 to 34.9 were submitted to BPD and monitored 12 months. Thirty-eight diabetic patients selected from a large database, kept 1 year on medical therapy, served as controls.
Nineteen male and 11 female. Mean age 56.4 ± 7.4 years, weight 84.8 ± 11.1 kg, BMI 30.6 ± 2.9 kg/m, waist circumference 104 ± 9.4 cm, diabetes duration 11.2 ± 6.9 years, HbA1c 9.3±1.5. Twelve patients on insulin. Fifteen (2 F) with BMI < 30 (mean: 28.1). No mortality or major adverse events occurred. BMI progressively decreased, stabilizing around 25 since the fourth month, without excessive weight loss. One year after BPD, mean HbA1c was 6.3%±0.8, with 25 patients (83%) controlled (HbA1c≤7%) on free diet, without antidiabetics, and the remaining improved. Acute insulin response to intravenous glucose had increased from 1.2 ± 2.9 to 4.2 ± 4.4 μIU/mL. Diabetes resolution correlated positively with BMI. HbA1c decreased at 1 year in the control group, along with an overall increased amount of antidiabetic therapy.
BPD improves or resolves diabetes in BMI 25 to 35 without causing excessive weight loss, its action being on insulin sensitivity and beta-cell function. The strikingly different response between morbidly obese and low BMI patients might depend on different beta-cell defect. ClinicalTrials.gov Identifier: NCT00996294.
胆胰分流术（BPD）可使大部分病态肥胖（BMI≥35kg/m）的 2 型糖尿病患者痊愈[BMI（体重指数）≥35kg/m]。然而，BMI 范围在 25.0 至 34.9kg/m 之间的患者，包括约 90%的糖尿病患者，缺乏关于 BPD 效果的研究。
如果 BPD 的效果不依赖于体重变化，那么对于轻度肥胖或超重的患者，在手术后体重几乎没有或没有减轻的情况下，这些效果应该仍然存在。30 名 BMI 为 25 至 34.9 的 2 型糖尿病患者接受了 BPD 治疗，并在 12 个月时进行了监测。从一个大型数据库中选择了 38 名接受了 1 年药物治疗的糖尿病患者作为对照组。
19 名男性和 11 名女性。平均年龄 56.4±7.4 岁，体重 84.8±11.1kg，BMI 30.6±2.9kg/m，腰围 104±9.4cm，糖尿病病程 11.2±6.9 年，HbA1c9.3±1.5。12 名患者使用胰岛素。15 名（2 名女性）BMI<30（平均：28.1）。无死亡或重大不良事件发生。BMI 逐渐下降，自第四个月起稳定在 25 左右，体重没有明显减轻。BPD 治疗 1 年后，平均 HbA1c 为 6.3%±0.8，25 名患者（83%）在不使用降糖药物的情况下通过自由饮食得到控制（HbA1c≤7%），其余患者的情况得到改善。静脉注射葡萄糖后急性胰岛素反应从 1.2±2.9μIU/mL 增加到 4.2±4.4μIU/mL。糖尿病的缓解与 BMI 呈正相关。对照组患者在 1 年内 HbA1c 下降，同时整体增加了降糖治疗。
BPD 可改善或治愈 BMI 为 25 至 35 的糖尿病，且不会导致体重明显减轻，其作用机制与胰岛素敏感性和胰岛β细胞功能有关。病态肥胖和低 BMI 患者之间截然不同的反应可能取决于不同的胰岛β细胞缺陷。临床试验注册编号：NCT00996294。
