Surgical-Medical Department for Digestive Diseases, Policlinico Umberto I, University La Sapienza, Rome, Italy.
Surg Obes Relat Dis. 2012 Jan-Feb;8(1):20-4. doi: 10.1016/j.soard.2011.06.015. Epub 2011 Jul 13.
Type 2 diabetes mellitus (T2DM) and obesity are diseases of epidemic proportions. Long-term realistic weight loss by nonsurgical methods has a variable effect on glycemic control, and only a proportion of patients with T2DM have a worthwhile response. Laparoscopic sleeve gastrectomy (LSG) has been proposed as an advantageous bariatric procedure for patients with a lower body mass index (BMI). Our objective was to compare the effects of LSG and medical therapy on patients with T2DM and a BMI of <35 kg/m(2).
A total of 18 nonmorbidly obese patients with T2DM, diagnosed according to the American Diabetes Association guidelines, were consecutively enrolled. Of these patients, 9 underwent LSG (group A) and 9 underwent conventional medical therapy (group B). The 2 groups were matched for BMI, glycated hemoglobin (HbA1c) and C-peptide levels, pretrial therapy type, and number of patients with a T2DM duration of >10 years.
In group A, T2DM resolution was achieved in 8 (88.8%) of the 9 patients (T2DM duration 5.2 yr). Hypertension was controlled in all 8 of 9 patients. Dyslipidemia was corrected. In 1 patient, obstructive sleep apnea syndrome improved. In group B, all 9 patients continued to have T2DM and required hypertensive and hypolipemic therapies throughout the observation period. At baseline, 3 patients were affected by obstructive sleep apnea syndrome and remained affected 1 year later.
The results of the present study have confirmed the efficacy of LSG in the treatment of nonmorbidly obese T2DM patients, with a remission rate of 88.8% without undesirable excessive weight loss. The results in this group of patients add to those obtained by us in patients with a BMI >35 kg/m(2).
2 型糖尿病（T2DM）和肥胖症是具有流行比例的疾病。通过非手术方法实现长期的现实减肥对血糖控制的影响是可变的，只有一部分 T2DM 患者有值得关注的反应。腹腔镜袖状胃切除术（LSG）已被提议作为一种有利于体重指数（BMI）较低的患者的减肥手术。我们的目的是比较 LSG 和药物治疗对 BMI<35kg/m²的 T2DM 患者的影响。
共有 18 名根据美国糖尿病协会指南诊断为非病态肥胖的 T2DM 患者连续入组。其中 9 例行 LSG（A 组），9 例行常规药物治疗（B 组）。两组在 BMI、糖化血红蛋白（HbA1c）和 C 肽水平、术前治疗类型和 T2DM 持续时间>10 年的患者数量上相匹配。
在 A 组，9 例中的 8 例（88.8%）T2DM 得到缓解（T2DM 持续时间 5.2 年）。9 例中的 8 例高血压得到控制。血脂异常得到纠正。1 例阻塞性睡眠呼吸暂停综合征改善。在 B 组，9 例患者均持续患有 T2DM，在整个观察期间需要高血压和降脂治疗。在基线时，3 例患有阻塞性睡眠呼吸暂停综合征，1 年后仍受其影响。
本研究结果证实了 LSG 治疗非病态肥胖 T2DM 患者的疗效，缓解率为 88.8%，且无不良的过度减重。这组患者的结果补充了我们在 BMI>35kg/m²患者中获得的结果。
