Nestvold Torunn Kristin, Nielsen Erik Waage, Lappegård Knut Tore
1 Department of Surgery, Nordland Hospital , Bodø, Norway .
Metab Syndr Relat Disord. 2013 Dec;11(6):441-6. doi: 10.1089/met.2013.0085. Epub 2013 Sep 17.
Patients with morbid obesity have a high risk of developing type 2 diabetes mellitus (T2DM). Important risk factors include body mass index (BMI), waist circumference, and insulin resistance. In this prospective study, we investigated if preoperative lifestyle changes followed by bariatric surgery could reduce these risk factors.
Forty nondiabetic obese patients aged 27-57 years participated. Baseline BMI was 36.1-65.6 kg/m(2). Fasting glucose, C-peptide, and glycated hemoglobin (HbA1c) were measured at baseline and 1 year after surgery. The patients underwent lifestyle changes for a period of 3 months prior to bariatric surgery and were followed for 1 year after surgery. The correlations between risk factors and weight reduction were assessed by a Pearson test.
Lifestyle changes resulted in a mean weight reduction of 14.3 kg. One year after bariatric surgery, the patients had a mean reduction in BMI of 17.6. Mean waist circumference was reduced from 136.5 cm to 100.7 cm. At baseline, all 40 patients had a waist circumference >100 cm; 1 year after surgery 18 of 40 patients did. At baseline, 11 out of 40 had insulin resistance (as defined by a homeostasis model score >3.99), whereas 1 year after surgery none of the patients did. There was a statistically significant correlation between change in waist circumference and change in insulin resistance (P<0.02), and between HbA1c and weight loss (P<0.002).
Our study shows that, in morbidly obese individuals, lifestyle changes followed by bariatric surgery led to a significant weight loss and a reduction in risk factors for development of T2DM.
病态肥胖患者患2型糖尿病（T2DM）的风险很高。重要的风险因素包括体重指数（BMI）、腰围和胰岛素抵抗。在这项前瞻性研究中，我们调查了术前生活方式改变继以减肥手术后是否能降低这些风险因素。
40名年龄在27至57岁之间的非糖尿病肥胖患者参与了研究。基线BMI为36.1至65.6kg/m²。在基线和手术后1年测量空腹血糖、C肽和糖化血红蛋白（HbA1c）。患者在减肥手术前进行了3个月的生活方式改变，并在手术后随访1年。通过Pearson检验评估风险因素与体重减轻之间的相关性。
生活方式改变导致平均体重减轻14.3kg。减肥手术后1年，患者的BMI平均降低了17.6。平均腰围从136.5cm降至100.7cm。基线时，所有40名患者的腰围均>100cm；手术后1年，40名患者中有18名如此。基线时，40名患者中有11名存在胰岛素抵抗（根据稳态模型评分>3.99定义），而手术后1年没有患者存在胰岛素抵抗。腰围变化与胰岛素抵抗变化之间存在统计学显著相关性（P<0.02），HbA1c与体重减轻之间也存在相关性（P<0.002）。
我们的研究表明，在病态肥胖个体中，生活方式改变继以减肥手术导致了显著的体重减轻和T2DM发生风险因素的降低。
