Centre for Obesity Research and Education (CORE), Monash University at The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
Diabetologia. 2014 Mar;57(3):463-8. doi: 10.1007/s00125-013-3129-0. Epub 2013 Dec 7.
AIMS/HYPOTHESIS: Obesity and dysglycaemia are major risk factors for type 2 diabetes. We determined if obese people undergoing laparoscopic adjustable gastric banding (LAGB) had a reduced risk of progressing from impaired fasting glucose (IFG) to diabetes.
This was a retrospective cohort study of obese people with IFG who underwent LAGB. Weight and diabetes outcomes after a minimum follow-up period of 4 years (mean ± SD 6.1 ± 1.7 years) were compared with those of Australian adults with IFG from a population-based study (AusDiab).
We identified 281 LAGB patients with baseline IFG. Their mean ± SD age and BMI were 46 ± 9 years and 46 ± 9 kg/m(2), respectively. The diabetes incidence for patients in the lowest, middle and highest weight loss tertile were 19.1, 3.4 and 1.8 cases/1,000 person-years, respectively. The AusDiab cohort had a lower BMI (28 ± 5 kg/m(2)) and a diabetes incidence of 12.5 cases/1,000 person-years. This increased to 20.5 cases/1,000 person-years when analysis was restricted to the 322 obese AusDiab participants, which was higher than the overall rate of 8.2 cases/1,000 person-years seen in the LAGB group (p = 0.02). Multivariable analysis of the combined LAGB and AusDiab data suggested that LAGB was associated with ∼75% lower risk of diabetes (OR 0.24 [95% CI 0.10, 0.57], p = 0.004).
CONCLUSIONS/INTERPRETATION: In obese people with IFG, weight loss after LAGB is associated with a substantially reduced risk of progressing to diabetes over ≥4 years. Bariatric surgery may be an effective diabetes prevention strategy in this population.
目的/假设：肥胖和糖调节受损是 2 型糖尿病的主要危险因素。我们确定了接受腹腔镜可调节胃束带术（LAGB）的肥胖患者，其从空腹血糖受损（IFG）进展为糖尿病的风险是否降低。
这是一项回顾性队列研究，纳入了接受 LAGB 的 IFG 肥胖患者。在至少 4 年的随访期（平均±标准差 6.1±1.7 年）后，比较了这些患者的体重和糖尿病结局与一项基于人群的研究（AusDiab）中 IFG 的澳大利亚成年人的结局。
我们确定了 281 例基线 IFG 的 LAGB 患者。他们的平均±标准差年龄和 BMI 分别为 46±9 岁和 46±9 kg/m²。体重减轻最低、中、高三分位数患者的糖尿病发病率分别为 19.1、3.4 和 1.8 例/1000 人年。AusDiab 队列的 BMI 较低（28±5 kg/m²），糖尿病发病率为 12.5 例/1000 人年。当分析仅限于 322 名肥胖的 AusDiab 参与者时，这一数字增加到 20.5 例/1000 人年，高于 LAGB 组总体的 8.2 例/1000 人年（p=0.02）。LAGB 和 AusDiab 数据的多变量分析表明，LAGB 与糖尿病风险降低约 75%相关（OR 0.24 [95%CI 0.10，0.57]，p=0.004）。
结论/解释：在 IFG 的肥胖患者中，LAGB 后体重减轻与糖尿病进展的风险显著降低相关，超过 4 年。减重手术可能是该人群中一种有效的糖尿病预防策略。
