Scopinaro Nicola, Adami Giovanni F, Papadia Francesco S, Camerini Giovanni, Carlini Flavia, Briatore Lucia, Andraghetti Gabriella, Catalano Mariafrancesca, Cordera Renzo
Department of Surgery, University of Genoa, School of Medicine, Genoa, Italy,
Obes Surg. 2014 Jul;24(7):1036-43. doi: 10.1007/s11695-014-1206-1.
This study aims to investigate if the benefits on glycemic control following Roux-en-Y gastric bypass (RYGB) in morbidly obese type 2 diabetes (T2DM) patients are maintained in the 30-35 kg/m(2) BMI (body mass index) range, comparing results with those in literature.
The study participants were twenty T2DM patients aging 35-70 years, BMI 30.0-34.9 kg/m(2), minimum diabetes duration 3 years, glycosylated haemoglobin (HbA1c) ≥7.5% despite good clinical practice medical therapy, submitted to laparoscopic RYGB, and monitored during 36 months. Twenty-seven matched diabetic patients as controls.
Five females, mean age 57 (42-69) years, weight 96.0 (70-111) kg, BMI 32.9 (30.3-34.9) kg/m(2), waist circumference 112 (100-128) cm, diabetes duration 14 (3-28) years, HbA1c 9.5 (7.5-14.2) %, and C-peptide 3.2 (1,6-9.1) mcg/l. Ten patients were on insulin. There was no mortality, and there were two major late complications. BMI and waist decreased stabilizing around 25 kg/m(2) and 92 cm. Fasting serum glucose and HbA1c reached values around 150 mg/dl and 7%, which subsequently maintained. There was remission in 25% of cases, control 45%, and all the others improved. HOMA-IR and insulin sensitivity index normalized at 1 month, then maintained. AIR and insulinogenic index showed no postoperative changes. Diabetes remission correlated negatively with duration (p < 0.05; r (2) = 0.61), while control positively with C-peptide (p < 0.05; r (2) = 0.19). In the control group, FSG, HbA1c, serum triglyceride, and cholesterol significantly decreased with considerable progressive increase of antidiabetic/antihyperlipemic therapy. All patients had HbA1c >7% at 2-3 years.
Glycemic control obtained by RYGB in this study was less good than that reported by others, apparently due to different patient selection criteria. Our results do not support RYGB weight loss-independent effect on beta-cell function in the T2DM patients with BMI 30-35 kg/m(2).
本研究旨在调查病态肥胖的2型糖尿病（T2DM）患者接受胃旁路术（RYGB）后血糖控制的益处是否能在体重指数（BMI）为30 - 35kg/m²的范围内得以维持，并与文献中的结果进行比较。
研究参与者为20例年龄在35 - 70岁、BMI为30.0 - 34.9kg/m²、糖尿病病程至少3年、尽管接受了良好的临床药物治疗但糖化血红蛋白（HbA1c）≥7.5%的T2DM患者，他们接受了腹腔镜RYGB手术，并在36个月内进行监测。另有27例匹配的糖尿病患者作为对照。
5名女性，平均年龄57（42 - 69）岁，体重96.0（70 - 111）kg，BMI 32.9（30.3 - 34.9）kg/m²，腰围112（100 - 128）cm，糖尿病病程14（3 - 28）年，HbA1c 9.5（7.5 - 14.2）%，C肽3.2（1.6 - 9.1）mcg/l。10例患者使用胰岛素。无死亡病例，有2例严重晚期并发症。BMI和腰围下降，稳定在约25kg/m²和92cm左右。空腹血糖和HbA1c达到约150mg/dl和7%的值，并随后维持。25%的病例病情缓解，45%为对照，其他所有患者病情改善。HOMA - IR和胰岛素敏感性指数在1个月时恢复正常，随后维持。AIR和胰岛素生成指数术后无变化。糖尿病缓解与病程呈负相关（p < 0.05；r² = 0.61），而对照与C肽呈正相关（p < 0.05；r² = 0.19）。在对照组中，空腹血糖、HbA1c、血清甘油三酯和胆固醇显著下降，同时抗糖尿病/抗高血脂治疗显著增加。所有患者在2 - 3年时HbA1c均>7%。
本研究中RYGB获得的血糖控制效果不如其他研究报告的好，显然是由于不同的患者选择标准。我们的结果不支持RYGB对BMI为30 - 35kg/m²的T2DM患者β细胞功能有不依赖体重减轻的作用。
