Lam Annika H L, Kim David D W, Cutfield Rick, Walker Cameron, Booth Michael
Department of Medicine, Waitemata District Health Board, Auckland, New Zealand.
N Z Med J. 2013 Nov 22;126(1386):21-30.
BACKGROUND/OBJECTIVES: Dramatic early postoperative improvement or resolution of type 2 diabetes mellitus (T2DM) has been widely reported after bariatric surgery but there is limited long-term data on T2DM outcome. Moreover, data on long-term weight outcomes of government funded bariatric surgery in New Zealand is lacking. We report weight and glycaemic outcomes in subjects with and without T2DM who underwent gastric bypass surgery (GBP) at Waitemata District Health Board (WDHB).
Clinical records of those who underwent a GBP (Roux-en-Y gastric bypass or loop gastric bypass) at WDHB between 2001 and 2007 were reviewed. Relevant pre- and postoperative data, including weight and diabetes related parameters, were collected from hospital records and analysed. Missing clinical data was attained by contacting patients, their primary practitioners and local laboratories, and also by performing HbA1c in T2DM subjects in whom latest diabetes status was unclear.
Data of 126 subjects was analysed. Their mean age was 43.7 years, 73% were female and 83% were Pakeha/European. Mean preoperative weight was 136.2 kg (SD plus or minus 29.1, range 81.3-241) with a mean BMI of 48.3 kg/m². Postoperative nadir weight was 80.6 kg (SD plus or minus 18.1, range 48.0-132.8) at 20.8 months (SD plus or minus 14.6, range 4-98) (BMI 28.6) with percentage of excess body weight loss (%EBWL) of 84.7%. Latest mean weight was 90.5 kg (SD plus or minus 18.8, range 57-140) (BMI 32.2, %EBWL 70.7%) at a mean of 63.4 months (SD plus or minus 19.7, range 12-109) post-op. Thirty four subjects (27.0%) had preoperative diagnosis of T2DM, of whom 29 (85.3%) had complete remission at some stage postoperatively. At the latest follow-up, 19 of 33 (57.6%) remained in complete remission, and the rest had either never remitted or had evidence of T2DM relapse after an initial remission. Weight loss outcomes were comparable between T2DM and non-T2DM subjects, and also between European and Maori and Pacific Islanders.
GBP resulted in substantial weight loss in essentially all subjects, and weight loss was well maintained over time. GBP also had dramatic and favourable effect on T2DM but did not uniformly result in prolonged diabetes remission. Long-term glycaemic surveillance is desirable.
背景/目的：减肥手术后2型糖尿病（T2DM）在术后早期显著改善或缓解的情况已被广泛报道，但关于T2DM长期转归的数据有限。此外，新西兰政府资助的减肥手术的长期体重转归数据也很缺乏。我们报告了在怀塔玛塔地区卫生局（WDHB）接受胃旁路手术（GBP）的有或无T2DM患者的体重和血糖转归情况。
回顾了2001年至2007年间在WDHB接受GBP（Roux-en-Y胃旁路术或袢式胃旁路术）患者的临床记录。从医院记录中收集并分析了相关的术前和术后数据，包括体重和糖尿病相关参数。通过联系患者、他们的初级医疗人员和当地实验室获取缺失的临床数据，对于最新糖尿病状态不明确的T2DM患者还进行了糖化血红蛋白检测。
分析了126名患者的数据。他们的平均年龄为43.7岁，73%为女性，83%为欧洲裔/白人。术前平均体重为136.2千克（标准差±29.1，范围81.3 - 241），平均体重指数为48.3千克/平方米。术后最低点体重在20.8个月（标准差±14.6，范围4 - 98）时为80.6千克（标准差±18.1，范围48.0 - 132.8）（体重指数28.6），超重体重减轻百分比（%EBWL）为84.7%。术后平均63.4个月（标准差±19.7，范围12 - 109）时的最新平均体重为90.5千克（标准差±18.8，范围57 - 140）（体重指数32.2，%EBWL 70.7%）。34名患者（27.0%）术前诊断为T2DM，其中29名（85.3%）在术后某个阶段完全缓解。在最新随访时，33名中的19名（57.6%）仍处于完全缓解状态，其余患者要么从未缓解，要么在最初缓解后有T2DM复发的证据。T2DM患者和非T2DM患者之间以及欧洲裔与毛利人和太平洋岛民之间的体重减轻转归相当。
GBP使基本上所有患者都实现了显著的体重减轻，且体重减轻随时间得到良好维持。GBP对T2DM也有显著且有利的影响，但并非都能导致糖尿病长期缓解。需要进行长期血糖监测。
