Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
Diabetes Care. 2013 Jan;36(1):20-6. doi: 10.2337/dc12-0779. Epub 2012 Oct 1.
To find clinically meaningful preoperative predictors of diabetes remission and conversely inadequate glycemic control after gastric bypass surgery. Predicting the improvement in glycemic control in those with type 2 diabetes after bariatric surgery may help in patient selection.
Preoperative details of 154 ethnic Chinese subjects with type 2 diabetes were examined for their influence on glycemic outcomes at 1 year after gastric bypass. Remission was defined as HbA(1c) ≤6%. Analysis involved binary logistic regression to identify predictors and provide regression equations and receiver operating characteristic curves to determine clinically useful cutoff values.
Remission was achieved in 107 subjects (69.5%) at 12 months. Diabetes duration <4 years, body mass >35 kg/m(2), and fasting C-peptide concentration >2.9 ng/mL provided three independent preoperative predictors and three clinically useful cutoffs. The regression equation classification plot derived from continuous data correctly assigned 84% of participants. A combination of two or three of these predictors allows a sensitivity of 82% and specificity of 87% for remission. Duration of diabetes (with different cutoff points) and C-peptide also predicted those cases in which HbA(1c) ≤7% was not attained. Percentage weight loss after surgery was also predictive of remission and of less satisfactory outcomes.
The glycemic response to gastric bypass is related to BMI, duration of diabetes, fasting C-peptide (influenced by insulin resistance and residual β-cell function), and weight loss. These data support and refine previous findings in non-Asian populations. Specific ethnic and procedural regression equations and cutoff points may vary.
寻找胃旁路手术后糖尿病缓解的临床有意义的术前预测因子，以及相反的血糖控制不足。预测 2 型糖尿病患者在接受减肥手术后血糖控制的改善可能有助于患者选择。
检查了 154 名汉族 2 型糖尿病患者的术前细节，以了解其对胃旁路术后 1 年血糖结果的影响。缓解定义为 HbA（1c）≤6%。分析采用二元逻辑回归确定预测因素，并提供回归方程和接收者操作特性曲线以确定临床有用的截断值。
12 个月时，107 名患者（69.5%）达到缓解。糖尿病病程<4 年、体重>35kg/m²和空腹 C 肽浓度>2.9ng/mL 提供了三个独立的术前预测因子和三个临床有用的截断值。从连续数据得出的回归方程分类图正确分配了 84%的参与者。将这些预测因子中的两个或三个组合起来，可以使缓解的敏感性为 82%，特异性为 87%。糖尿病病程（不同的截断点）和 C 肽也预测了 HbA（1c）≤7%未达到的病例。手术后体重减轻百分比也是缓解和不太满意结果的预测因素。
胃旁路术后的血糖反应与 BMI、糖尿病病程、空腹 C 肽（受胰岛素抵抗和残余β细胞功能影响）和体重减轻有关。这些数据支持并细化了以前在非亚洲人群中的发现。特定的种族和程序回归方程和截断值可能会有所不同。
