Department of Internal Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy.
J Clin Endocrinol Metab. 2011 Sep;96(9):E1372-9. doi: 10.1210/jc.2011-0446. Epub 2011 Jul 21.
Bariatric surgery can induce remission in a high proportion of severely obese patients with type 2 diabetes mellitus (T2DM).
Our objective was to investigate predictors and mechanisms of surgery-induced diabetes remission.
Forty-three morbidly obese subjects (body mass index = 45.6 ± 5.0 kg/m(2)), 32 with T2DM and 11 nondiabetic [normal glucose tolerance (NGT)], participated at a clinical research center.
Patients underwent Roux-en-Y gastric bypass.
Diabetes remission and β-cell function were evaluated.
Subjects were tested before and 45 d and 1 yr after surgery. Weight decreased similarly in T2DM and NGT (-39 kg at 1 yr, P < 0.0001). Insulin sensitivity improved in both groups in proportion to the changes in body mass index but remained lower in T2DM than NGT (386 ± 91 vs. 479 ± 89 ml/min · m(2), P < 0.01). Based on glycosylated hemoglobin and oral glucose testing, diabetes had remitted in nine patients at 45 d and in an additional 16 at 1 yr. In T2DM, β-cell glucose sensitivity increased early after surgery but was no further improved and still abnormal at 1 yr [median, 48 (coefficient interval, 53) pmol/min · m(2) · mm vs. median, 100 (coefficient interval, 68) of NGT, P < 0.001]. Baseline β-cell glucose sensitivity was progressively worse in early remitters, late remitters, and nonremitters (median, 54[coefficient interval, 50] vs. median, 22[coefficient interval, 26] vs. median, 4[coefficient interval, 10] pmol/min · m(2) · mm) and, by logistic regression, was the only predictor of failure [odds ratio for bottom tertile = 7.9 (95% confidence interval = 1.2-51.9); P = 0.03].
In morbid obesity, Roux-en-Y gastric bypass causes rapid and profound metabolic adaptations; insulin sensitivity improves in proportion to the weight loss, and β-cell glucose sensitivity increases independently of weight loss. Over a period of 1 yr after surgery, diabetes remission depends on the starting degree of β-cell dysfunction.
减重手术可以使很大一部分患有 2 型糖尿病（T2DM）的严重肥胖患者得到缓解。
我们的目的是研究手术诱导糖尿病缓解的预测因素和机制。
43 名病态肥胖患者（体重指数= 45.6 ± 5.0 kg/m2），32 名患有 T2DM，11 名非糖尿病（正常糖耐量（NGT）），在临床研究中心参与。
患者接受 Roux-en-Y 胃旁路手术。
糖尿病缓解和β细胞功能评估。
受试者在手术前和 45 天及 1 年后进行测试。T2DM 和 NGT 的体重均相似下降（1 年后下降 39 公斤，P < 0.0001）。两组的胰岛素敏感性均随着体重指数的变化而相应改善，但 T2DM 仍低于 NGT（386 ± 91 与 479 ± 89 ml/min·m2，P < 0.01）。根据糖化血红蛋白和口服葡萄糖耐量试验，9 例患者在 45 天时糖尿病缓解，另外 16 例患者在 1 年后缓解。在 T2DM 中，β细胞葡萄糖敏感性在手术后早期增加，但在 1 年后并未进一步改善，仍异常[中位数 48（置信区间，53）pmol/min·m2·mm，与 NGT 的中位数 100（置信区间，68）相比，P < 0.001]。早期缓解者、晚期缓解者和未缓解者的基线β细胞葡萄糖敏感性逐渐恶化（中位数 54[置信区间，50]与中位数 22[置信区间，26]与中位数 4[置信区间，10] pmol/min·m2·mm），并且通过逻辑回归，β细胞葡萄糖敏感性是失败的唯一预测因素[最底层三分位数的优势比= 7.9（95%置信区间= 1.2-51.9）；P = 0.03]。
在病态肥胖中，Roux-en-Y 胃旁路手术引起快速而深刻的代谢适应；胰岛素敏感性随着体重减轻而改善，β细胞葡萄糖敏感性独立于体重减轻而增加。手术后 1 年内，糖尿病缓解取决于β细胞功能障碍的起始程度。
