Department of Surgery, University of Genoa Medical School, Genoa, Italy.
Obes Surg. 2011 Jul;21(7):880-8. doi: 10.1007/s11695-011-0407-0.
Beneficial effects of BPD on T2DM in BMI >35 kg/m(2) patients are far better than those in patients with BMI 25-35. This study was aimed at investigating if a similar difference exists between patients with mild obesity (OB, BMI 30-35) or simple overweight (OW, BMI 25-30).
Fifteen OB (six M) and 15 OW (13 M), diabetic for ≥ 3 years, with HbA1c ≥ 7.5% despite medical therapy, underwent BPD. OB/OW: age 55.1 ± 8.0/57.8 ± 6.7 years, BMI 33.1 ± 1.5/28.0 ± 1.3 kg/m(2), diabetes duration 11.6 ± 8.0/11.1 ± 6.1 years, insulin therapy 4/8 p. FSG and HbA1c were determined preoperatively and up to 2 years. Insulin resistance and beta-cell function were explored by means of HOMA-IR and IVGTT (AIR). Thirty-eight diabetic patients on medical therapy served as controls.
Mean BMI stabilized around 27 since the 4th month in OB, and 24 since 1st month in OW. FSG in OB/OW preop, 1, 12, 24 months: 234 ± 76/206 ± 62 mg/dL, 154 ± 49/176 ± 75, 131 ± 32/167 ± 48, 134 ± 41/154 ± 41 (cross-sectional n.s. at all times); HbA1c: 9.5 ± 1.6/9.1 ± 1.3, 7.3 ± 1.1/7.3 ± 1.2, 5.9 ± 0.6/7.1 ± 1.1 (p < 0.01), 5.9 ± 0.9/6.9 ± 1.1 (p < 0.01). HOMA-IR, preoperatively 10.7 ± 5.8/7.5 ± 5.4, went below 3.0 at 1 month and remained such until 2 years in both groups. AIR, preoperatively 1.11 ± 3.17/1.27 ± 2.68 μIU/mL, in OB significantly increased at 4 months to 7.63 ± 5.79, maintained up to 2 years with 6.95 ± 3.19, whereas in OW, statistical significance was reached only at 2 years with 5.02 ± 4.87.
Significantly different BPD effect, thus biological severity of T2DM, also exists between mildly obese and simply overweight patients. The rise of AIR allows hoping that an increase of beta-cell mass may occur in the long run.
对于 BMI>35kg/m²的 2 型糖尿病患者，BPD 的有益效果远优于 BMI 为 25-35kg/m²的患者。本研究旨在探讨轻度肥胖（OB，BMI 为 30-35）或单纯超重（OW，BMI 为 25-30）患者之间是否存在类似的差异。
15 名 OB（6 名男性）和 15 名 OW（13 名男性），糖尿病病程≥3 年，尽管接受了药物治疗，但 HbA1c 仍≥7.5%，接受了 BPD 手术。OB/OW：年龄 55.1±8.0/57.8±6.7 岁，BMI 33.1±1.5/28.0±1.3kg/m²，糖尿病病程 11.6±8.0/11.1±6.1 年，胰岛素治疗 4/8 例。术前及术后 2 年检测 FSG 和 HbA1c。通过 HOMA-IR 和 IVGTT（AIR）检测胰岛素抵抗和β细胞功能。38 名接受药物治疗的糖尿病患者作为对照组。
OB 组自第 4 个月起 BMI 稳定在 27 左右，OW 组自第 1 个月起 BMI 稳定在 24 左右。OB/OW 组术前、1 个月、12 个月、24 个月的 FSG 为 234±76/206±62mg/dL、154±49/176±75、131±32/167±48、134±41/154±41（横截面上各时间点均无统计学差异）；HbA1c 为 9.5±1.6/9.1±1.3、7.3±1.1/7.3±1.2、5.9±0.6/7.1±1.1（p<0.01）、5.9±0.9/6.9±1.1（p<0.01）。HOMA-IR 术前为 10.7±5.8/7.5±5.4，OB 组于 1 个月时降至 3.0 以下，并在 2 年内保持不变。AIR 术前为 1.11±3.17/1.27±2.68μIU/mL，OB 组于 4 个月时显著升高至 7.63±5.79，至 2 年时保持在 6.95±3.19，而 OW 组仅在 2 年时达到统计学意义，为 5.02±4.87。
BPD 的效果存在显著差异，因此 2 型糖尿病的生物学严重程度也存在差异，在轻度肥胖和单纯超重患者之间存在差异。AIR 的升高表明β细胞质量可能会随着时间的推移而增加。
