Mostaedi Rouzbeh, Lackey Denise E, Adams Sean H, Dada Stephen A, Hoda Zahid A, Ali Mohamed R
Department of Surgery, University of California, Davis, 2221 Stockton Boulevard, Cypress Building, Sacramento, CA, 95817, USA.
Obes Surg. 2014 Jun;24(6):927-35. doi: 10.1007/s11695-014-1196-z.
Pharmacotherapy is considered the primary treatment modality for diabetes mellitus (DM), hypertension (HTN), and dyslipidemia (DYS). We sought to investigate the status of DM, HTN, and DYS in patients who seek bariatric surgery.
Demographic and comorbidity history were prospectively collected on 1,508 patients referred for bariatric consultation at a single institution from February 2008 to March 2012. We utilized published consensus guidelines (GL) to benchmark the efficacy of standard pharmacotherapy for these metabolic diseases, and 881 patients met the study design criteria.
Most patients exhibited at least one form of metabolic dysregulation (pre-DM or DM, 75.8%; pre-HTN or HTN, 91.1%; pre-DYS or DYS, 84.0%; metabolic syndrome, 76.0%). The majority of patients either did not meet GL treatment goals (DM, 45.7%; HTN, 39.5%; DYS, 22.3%) or were previously undiagnosed (DM, 15.8%; HTN, 13.7%; DYS, 41.7%). Non-GL pharmacotherapy was significantly less effective than GL pharmacotherapy at achieving treatment goals for DM (31.8 vs. 53.2%, p < 0.001) and HTN (43.6 vs. 63.2%, p = 0.007). Patients with concurrent DM, HTN, and DYS (35.5%) were less likely than patients with only one or two of these metabolic diseases to achieve GL treatment goals for HTN (38.1 vs. 72.6%, p < 0.001) and DYS (55.7 vs. 73.8%, p = 0.002). Only 8.0% of these patients achieved treatment goals for all three metabolic comorbidities.
In this patient group, DM, HTN, and DYS were poorly compensated, even when pharmacotherapy was consistent with published GL. This may be due to disease burden in bariatric surgery candidates or to inadequate medical management prior to presentation.
药物治疗被认为是糖尿病（DM）、高血压（HTN）和血脂异常（DYS）的主要治疗方式。我们试图调查寻求减肥手术患者的DM、HTN和DYS状况。
前瞻性收集了2008年2月至2012年3月在单一机构接受减肥咨询的1508例患者的人口统计学和合并症病史。我们利用已发表的共识指南（GL）来衡量这些代谢性疾病标准药物治疗的疗效，881例患者符合研究设计标准。
大多数患者表现出至少一种形式的代谢失调（糖尿病前期或糖尿病，75.8%；高血压前期或高血压，91.1%；血脂异常前期或血脂异常，84.0%；代谢综合征，76.0%）。大多数患者要么未达到GL治疗目标（糖尿病，45.7%；高血压，39.5%；血脂异常，22.3%），要么之前未被诊断（糖尿病，15.8%；高血压，13.7%；血脂异常，41.7%）。在实现糖尿病（31.8%对53.2%，p<0.001）和高血压（43.6%对63.2%，p = 0.007）治疗目标方面，非GL药物治疗明显不如GL药物治疗有效。同时患有糖尿病、高血压和血脂异常的患者（35.5%）比仅患有其中一两种代谢性疾病的患者实现高血压（38.1%对72.6%，p<0.001）和血脂异常（55.7%对73.8%，p = 0.002）GL治疗目标的可能性更小。这些患者中只有8.0%实现了所有三种代谢合并症的治疗目标。
在该患者群体中，即使药物治疗符合已发表的GL，糖尿病、高血压和血脂异常的控制情况仍很差。这可能是由于减肥手术候选者的疾病负担，或就诊前医疗管理不足所致。
