*Sarah W. Stedman Nutrition & Metabolism Center, Duke University Medical Center, Durham, NC †Department of Medicine, National University Health System, Singapore; and ‡Department of General Surgery, Duke University Medical Center, Durham, NC.
Ann Surg. 2014 Mar;259(3):494-501. doi: 10.1097/SLA.0b013e318294d19c.
The long-term changes in insulin sensitivity and β-cell function in morbidly obese patients with type 2 diabetes mellitus who undergo Roux-en-Y gastric bypass (RYGB) surgery or standard medical care remain unclear. We prospectively studied longitudinal changes of glucostatic parameters in morbidly obese patients with type 2 diabetes mellitus undergoing RYGB surgery or diabetes support and education (DSE).
Sixty-one morbidly obese subjects (41.7 ± 0.6 kg/m) with type 2 diabetes mellitus were assigned to RYGB surgery (n = 30) or DSE (n = 31). They were matched for sex, age, and body weight. Insulin sensitivity index (Si) and acute insulin response (AIR) were derived from frequently sampled intravenous glucose tolerance test. Body composition was measured using dual-energy x-ray absorptiometry. General linear model with repeated measures was used to examine the longitudinal changes (baseline, 6 months, 12 months) in these parameters.
At 12-month follow-up, significant improvement in obesity measures, body composition, glucose homeostasis, Si, and AIR was observed after RYGB surgery and weight loss. These outcomes were not influenced by preoperative insulin use. Although there were no significant changes in the body composition among DSE subjects, they experienced a decline in the Si and AIR, along with an increase in fasting glucose and HbA1c. The between-group differences in Si and AIR at 12-month follow-up were completely attenuated with adjustment to changes in body weight.
The long-term effects of RYGB surgery on glucostatic parameters are partly dependent on weight loss. In morbidly obese patients with diabetes who were offered DSE, a progressive decline in the glucose homeostasis and glucostatic parameters is observed despite absence of weight gain. (NCT00787670).
患有 2 型糖尿病的病态肥胖患者接受 Roux-en-Y 胃旁路手术（RYGB）或标准医疗护理后，胰岛素敏感性和β细胞功能的长期变化尚不清楚。我们前瞻性研究了接受 RYGB 手术或糖尿病支持和教育（DSE）的 2 型糖尿病病态肥胖患者糖稳态参数的纵向变化。
61 名患有 2 型糖尿病的病态肥胖患者（41.7 ± 0.6 kg/m）被分配接受 RYGB 手术（n = 30）或 DSE（n = 31）。他们在性别、年龄和体重方面相匹配。胰岛素敏感指数（Si）和急性胰岛素反应（AIR）是从频繁采样的静脉葡萄糖耐量试验中得出的。使用双能 X 线吸收法测量身体成分。使用重复测量的一般线性模型来检查这些参数的纵向变化（基线、6 个月、12 个月）。
在 12 个月的随访中，RYGB 手术后和体重减轻后，肥胖指标、身体成分、血糖稳态、Si 和 AIR 显著改善。这些结果不受术前胰岛素使用的影响。尽管 DSE 组的身体成分没有明显变化，但 Si 和 AIR 下降，空腹血糖和 HbA1c 增加。调整体重变化后，12 个月随访时 Si 和 AIR 的组间差异完全减弱。
RYGB 手术对糖稳态参数的长期影响部分取决于体重减轻。在接受 DSE 的糖尿病肥胖患者中，尽管体重没有增加，但观察到血糖稳态和糖稳态参数逐渐下降。（NCT00787670）。
