*Bariatric and Metabolic Institute and †Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH; and ‡Department of Surgery, Loyola University, Chicago, IL.
Ann Surg. 2013 Oct;258(4):628-36; discussion 636-7. doi: 10.1097/SLA.0b013e3182a5034b.
Evaluate the long-term effects of bariatric surgery on type 2 diabetes (T2DM) remission and metabolic risk factors.
Although the impressive antidiabetic effects of bariatric surgery have been shown in short- and medium-term studies, the durability of these effects is uncertain. Specifically, long-term remission rates following bariatric surgery are largely unknown.
Clinical outcomes of 217 patients with T2DM who underwent bariatric surgery between 2004 and 2007 and had at least 5-year follow-up were assessed. Complete remission was defined as glycated hemoglobin (A1C) less than 6% and fasting blood glucose (FBG) less than 100 mg/dL off diabetic medications. Changes in other metabolic comorbidities, including hypertension, dyslipidemia, and diabetic nephropathy, were assessed.
At a median follow-up of 6 years (range: 5-9) after surgery (Roux-en-Y gastric bypass, n = 162; gastric banding, n = 32; sleeve gastrectomy, n = 23), a mean excess weight loss (EWL) of 55% was associated with mean reductions in A1C from 7.5% ± 1.5% to 6.5% ± 1.2% (P < 0.001) and FBG from 155.9 ± 59.5 mg/dL to 114.8 ± 40.2 mg/dL (P < 0.001). Long-term complete and partial remission rates were 24% and 26%, respectively, whereas 34% improved (>1% decrease in A1C without remission) from baseline and 16% remained unchanged. Shorter duration of T2DM (P < 0.001) and higher long-term EWL (P = 0.006) predicted long-term remission. Recurrence of T2DM after initial remission occurred in 19% and was associated with longer duration of T2DM (P = 0.03), less EWL (P = 0.02), and weight regain (P = 0.015). Long-term control rates of low high-density lipoprotein, high low-density lipoprotein, high triglyceridemia, and hypertension were 73%, 72%, 80%, and 62%, respectively. Diabetic nephropathy regressed (53%) or stabilized (47%).
Bariatric surgery can induce a significant and sustainable remission and improvement of T2DM and other metabolic risk factors in severely obese patients. Surgical intervention within 5 years of diagnosis is associated with a high rate of long-term remission.
评估减重手术对 2 型糖尿病（T2DM）缓解和代谢风险因素的长期影响。
尽管减重手术在短期和中期研究中显示出令人印象深刻的降糖效果，但这些效果的持久性尚不确定。具体而言，减重手术后的长期缓解率尚不清楚。
评估了 217 例 2004 年至 2007 年间接受减重手术且随访时间至少 5 年的 T2DM 患者的临床结局。完全缓解定义为糖化血红蛋白（A1C）<6%且停用降糖药物后空腹血糖（FBG）<100mg/dL。评估了其他代谢合并症（包括高血压、血脂异常和糖尿病肾病）的变化。
在手术后中位随访 6 年（范围：5-9 年）（Roux-en-Y 胃旁路术，n=162；胃束带术，n=32；袖状胃切除术，n=23），平均体重减轻 55%与 A1C 从 7.5%±1.5%降至 6.5%±1.2%（P<0.001）和 FBG 从 155.9±59.5mg/dL降至 114.8±40.2mg/dL（P<0.001）相关。长期完全缓解率和部分缓解率分别为 24%和 26%，而 34%的患者（A1C 下降>1%但未缓解）从基线改善，16%的患者无变化。T2DM 的持续时间较短（P<0.001）和长期体重减轻较多（P=0.006）预测长期缓解。初始缓解后 T2DM 的复发率为 19%，与 T2DM 的持续时间较长（P=0.03）、体重减轻较少（P=0.02）和体重反弹（P=0.015）有关。低高密度脂蛋白、高低密度脂蛋白、高三酰甘油血症和高血压的长期控制率分别为 73%、72%、80%和 62%。糖尿病肾病缓解（53%）或稳定（47%）。
减重手术可显著且持续缓解和改善严重肥胖患者的 T2DM 及其他代谢风险因素。诊断后 5 年内进行手术干预与长期缓解率较高相关。
