Surgical-Medical Department for Digestive Diseases, Policlinico Umberto I, Sapienza University of Rome, Italy.
Surg Obes Relat Dis. 2011 Nov-Dec;7(6):697-702. doi: 10.1016/j.soard.2011.08.014. Epub 2011 Aug 28.
Several studies have demonstrated a high rate of type 2 diabetes mellitus (T2DM) resolution after sleeve gastrectomy. Different prognostic factors have been hypothesized for T2DM remission after bariatric surgery. Our objectives were to analyze the role of T2DM duration as an independent prognostic factor for remission.
From January 2008 to September 2010, 56 obese patients with T2DM underwent sleeve gastrectomy. Group A consisted of 16 patients who had lived with T2DM for >10 years (12 women and 4 men, mean body mass index 42.7 kg/m2). Group B included 40 obese patients who had lived with T2DM for <10 years (29 women and 11 men, mean body mass index 44.9 kg/m2).
In group A, 43.7% were treated with oral hypoglycemics, 6.3% with insulin, and 50% with oral hypoglycemics and insulin. In group B, 87.5% were treated with oral hypoglycemics, 5% with dietary therapy, and 7.5% with insulin. The preoperative average glycemia, glycosylated hemoglobin, and C-peptide value was 206.2 mg/dL, 9.5%, and 2.8 μg/L in group A and 134 mg/dL, 7.1%, and 4.5 μg/L in group B, respectively (P < .05 for all). The T2DM remission rate in all 56 patients was 80.3%. However, in group B, the resolution rate was 100%, but in group A, the resolution rate was 31%. Patients without complete remission were more sensitive to lower doses of antidiabetic drugs.
Sleeve gastrectomy is effective in the treatment of obese patients with T2DM. The duration of T2DM seems to be of paramount importance as a prognostic factor, with 10 years representing a cutoff between a 100% rate of remission and significantly lower rates of remission.
多项研究表明袖状胃切除术（Sleeve gastrectomy）后 2 型糖尿病（type 2 diabetes mellitus，T2DM）的缓解率较高。人们假设了多种用于预测减重手术后 T2DM 缓解的预后因素。我们的目的是分析 T2DM 病程作为独立预后因素对缓解的作用。
2008 年 1 月至 2010 年 9 月，56 例 T2DM 肥胖患者接受了袖状胃切除术。A 组包括病程＞10 年的 16 例患者（12 名女性和 4 名男性，平均体重指数为 42.7kg/m2）。B 组包括病程＜10 年的 40 例肥胖患者（29 名女性和 11 名男性，平均体重指数为 44.9kg/m2）。
A 组中，43.7%的患者接受口服降糖药治疗，6.3%接受胰岛素治疗，50%的患者同时接受口服降糖药和胰岛素治疗。B 组中，87.5%的患者接受口服降糖药治疗，5%的患者接受饮食治疗，7.5%的患者接受胰岛素治疗。A 组术前平均血糖、糖化血红蛋白和 C 肽值分别为 206.2mg/dL、9.5%和 2.8μg/L，B 组分别为 134mg/dL、7.1%和 4.5μg/L（均 P＜0.05）。56 例患者的 T2DM 缓解率为 80.3%。然而，B 组的缓解率为 100%，而 A 组的缓解率为 31%。未完全缓解的患者对较低剂量的降糖药物更为敏感。
袖状胃切除术治疗肥胖 2 型糖尿病患者有效。T2DM 病程似乎是一个非常重要的预后因素，病程 10 年是缓解率达到 100%和显著降低缓解率的分水岭。
