Department of Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
Surg Obes Relat Dis. 2012 Nov-Dec;8(6):685-90. doi: 10.1016/j.soard.2011.08.002. Epub 2011 Aug 10.
Hemoglobin A1c (HbA1c) is a reliable marker for long-term glycemic control in obese diabetic patients. Roux-en-Y gastric bypass improves HbA1c levels over time. However, it is not clear whether the preoperative HbA1c level is a predictor of the outcome in these patients. Our objectives were to understand the predictive capacity of the preoperative HbA1c level in gastric bypass patients at a single university-based Bariatric Center of Excellence.
We performed a retrospective review of 468 charts from 2006 to 2009 of patients who had undergone Roux-en-Y gastric bypass. Using their preoperative HbA1c status, the patients were categorized and the postoperative outcomes compared.
Of the 468 patients reviewed, 310 (66.2%) had a HbA1c of <6.5% (group 1), 92 (19.4%) had a HbA1c of 6.5-7.9% (group 2), and 66 (14.1%) had a HbA1c level of >8.0% (group 3). No difference was found among the 3 groups in baseline body mass index, race, procedure type, length of stay, hospital cost, and smoking status. Groups 2 and 3 were associated with older age, male gender, and higher baseline creatinine. Groups 2 and 3 also had a proportionally greater inpatient postoperative blood glucose level. An elevated postoperative glucose level was independently associated with wound infection (P = .008) and acute renal failure (P = .04). Also, group 3 experienced worse outcomes, including less weight loss at 18 months and fewer diabetic remissions. Over time, however, the vast majority in all groups achieved excellent chronic glycemic control, with HbA1c <6.5% after Roux-en-Y gastric bypass.
Poor preoperative glycemic control is associated with worse glucose level control postoperatively, fewer diabetic remissions, and less weight loss. An elevated mean postoperative glucose level is independently associated with increased morbidity.
血红蛋白 A1c（HbA1c）是肥胖糖尿病患者长期血糖控制的可靠标志物。Roux-en-Y 胃旁路术可改善 HbA1c 水平随时间的变化。然而，目前尚不清楚术前 HbA1c 水平是否是这些患者结局的预测指标。我们的目的是了解在单一大学减重卓越中心的 Roux-en-Y 胃旁路术患者中，术前 HbA1c 水平的预测能力。
我们对 2006 年至 2009 年在我们减重卓越中心接受 Roux-en-Y 胃旁路术的 468 例患者的病历进行了回顾性分析。根据术前 HbA1c 状态对患者进行分类，并比较术后结果。
在 468 例患者中，310 例（66.2%）HbA1c＜6.5%（组 1），92 例（19.4%）HbA1c 为 6.5-7.9%（组 2），66 例（14.1%）HbA1c 水平＞8.0%（组 3）。三组患者在基线体重指数、种族、手术类型、住院时间、住院费用和吸烟状况方面无差异。组 2 和组 3 与年龄较大、男性和较高的基线肌酐相关。组 2 和组 3 还表现出更高比例的术后住院血糖水平升高。术后血糖水平升高与伤口感染（P =.008）和急性肾衰竭（P =.04）独立相关。此外，组 3 的术后结果较差，包括 18 个月时体重减轻较少和糖尿病缓解较少。然而，随着时间的推移，所有组的绝大多数患者均获得了出色的慢性血糖控制，术后 HbA1c＜6.5%。
术前血糖控制不佳与术后血糖控制较差、糖尿病缓解较少和体重减轻较少相关。术后平均血糖水平升高与发病率增加独立相关。
