Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
Ann Surg. 2012 Feb;255(2):287-93. doi: 10.1097/SLA.0b013e318232b033.
To compare the relative efficacy of medical management, the duodenal switch (DS), and the laparoscopic adjustable gastric band (LAGB) to the Roux-en-Y gastric bypass (RYGB) for treatment of type 2 diabetes mellitus (T2DM).
The RYGB resolves T2DM in a high proportion of patients and is considered the standard operation for T2DM resolution in morbidly obese patients. However, no data exist comparing the efficacy of medical management and other bariatric operations to the RYGB for treatment of T2DM in comparable patient populations.
We performed a retrospective case-matched study of morbidly obese patients with T2DM who had undergone medical management (nonsurgical controls [NSC]; N = 29), LAGB (N = 30), or DS (N = 27) and were compared with matched T2DM patients who had undergone RYGB. Matching was performed with respect to age, sex, body mass index, and hemoglobin A1C (HbA1C). Outcomes assessed were changes in body mass index, HbA1C, and diabetes medication scores at 1 year.
The Roux-en-Y gastric bypass produced greater weight loss, HbA1C normalization, and medication score reduction compared to both NSC and LAGB-matched cohorts. Duodenal switch produced greater reductions in HbA1C and medication score than RYGB, despite no greater weight loss at 1 year. Surgical complications were rarely life threatening.
This study provides an important perspective about the comparative efficacy of LAGB, DS, and NSC to the RYGB for treatment of T2DM among obese patients. After 1 year of follow-up, RYGB is superior to NSC and LAGB with respect to weight loss and improvement in diabetes whereas DS is superior to RYGB in reducing HbA1C and medication score.
比较医学治疗、十二指肠转流术（DS）和腹腔镜可调节胃束带术（LAGB）与 Roux-en-Y 胃旁路术（RYGB）治疗 2 型糖尿病（T2DM）的相对疗效。
RYGB 能使相当一部分 T2DM 患者得到缓解，被认为是病态肥胖患者 T2DM 缓解的标准手术。然而，目前尚无比较医学治疗和其他减重手术与 RYGB 治疗可比患者人群 T2DM 的疗效的数据。
我们对接受过医学治疗（非手术对照组 [NSC]；N=29）、LAGB（N=30）或 DS（N=27）的 T2DM 肥胖患者进行了回顾性病例匹配研究，并与接受过 RYGB 的匹配 T2DM 患者进行了比较。匹配因素包括年龄、性别、体重指数和血红蛋白 A1C（HbA1C）。评估的结果是在 1 年时体重指数、HbA1C 和糖尿病药物评分的变化。
与 NSC 和 LAGB 匹配组相比，RYGB 术后体重减轻更多，HbA1C 正常化和药物评分降低更多。尽管 1 年后体重减轻无差异，但 DS 组的 HbA1C 和药物评分降低幅度大于 RYGB 组。手术并发症很少危及生命。
这项研究提供了一个关于 LAGB、DS 和 NSC 与 RYGB 治疗肥胖患者 T2DM 的相对疗效的重要视角。在 1 年的随访后，RYGB 在减轻体重和改善糖尿病方面优于 NSC 和 LAGB，而 DS 在降低 HbA1C 和药物评分方面优于 RYGB。
