2 型糖尿病患者胃旁路手术后 2 年的代谢结果：一项观察性队列研究。

Metabolic outcomes 2 years following gastric bypass surgery in people with type 2 diabetes: an observational cohort study.

机构信息

From the Faculty of Medical and Human Sciences, The University of Manchester, Manchester, Department of Diabetes, Endocrinology and Obesity Medicine, Salford Royal NHS Foundation Trust and University Teaching Hospital, Salford, Department of Bariatric and Upper Gastrointestinal Surgery, Salford Royal NHS Foundation Trust and University Teaching Hospital, Salford and Cardiovascular Trials Unit, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK From the Faculty of Medical and Human Sciences, The University of Manchester, Manchester, Department of Diabetes, Endocrinology and Obesity Medicine, Salford Royal NHS Foundation Trust and University Teaching Hospital, Salford, Department of Bariatric and Upper Gastrointestinal Surgery, Salford Royal NHS Foundation Trust and University Teaching Hospital, Salford and Cardiovascular Trials Unit, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK.

出版信息

QJM. 2014 Sep;107(9):721-6. doi: 10.1093/qjmed/hcu060. Epub 2014 Mar 19.

DOI:10.1093/qjmed/hcu060

PMID:24652654

Abstract

BACKGROUND

Gastric bypass surgery induces early remission or significant improvement in type 2 diabetes (T2D).

AIM

To assess effectiveness of stopping glucose-lowering treatment at the time of surgery.

DESIGN

Observational cohort analysis.

METHODS

We identified 101 patients (62 women) with T2D who had undergone gastric bypass surgery at a mean (SD, standard deviation) age of 51.4 (9.0) years. We recorded weight, body mass index (BMI), glycosylated haemoglobin (HbA1c), blood pressure (BP), total and high-density lipoprotein (HDL) cholesterol preoperatively and at a median 4, 12 and 24 months postoperatively, and changes to glucose-lowering therapy.

RESULTS

Mean (SD) baseline BMI was 50.3 (6.3) kg/m(2), HbA1c 65.3 (18.5) mmol/mol, systolic BP 146.0 (18.0) mmHg, diastolic BP 87.0 (10.8) mmHg and total cholesterol-to-HDL cholesterol ratio 4.0 (1.2). Mean (95% confidence interval) reduction in BMI was 16.4 (14.1-18.7) kg/m(2), HbA1c 23.6 (17.6-29.6) mmol/mol, systolic BP 12.9 (5.9-19.8) mmHg, diastolic BP 6.1 (1.8-10.5) mmHg and total cholesterol-to-HDL cholesterol ratio 1.1 (0.6-1.5) at 24 months (P < 0.001 for all measures). Although 91% of patients were receiving glucose-lowering therapies preoperatively, complete (HbA1c < 42 mmol/mol) and partial (HbA1c 42-48 mmol/mol) remissions of T2D were seen in 62.1% and 5.2% at 2 years postoperatively.

CONCLUSIONS

Cessation of glucose-lowering therapies in people with T2D at the time of gastric bypass surgery was clinically effective. The majority of patients remained in complete or partial remission of diabetes up to 2 years postoperatively.

摘要

背景

胃旁路手术可诱导 2 型糖尿病（T2D）早期缓解或显著改善。

目的

评估手术时停止降糖治疗的效果。

设计

观察性队列分析。

方法

我们确定了 101 名（62 名女性）T2D 患者，他们在平均（标准差）年龄 51.4（9.0）岁时接受了胃旁路手术。我们记录了体重、体重指数（BMI）、糖化血红蛋白（HbA1c）、血压（BP）、术前和术后中位数为 4、12 和 24 个月时的总胆固醇和高密度脂蛋白（HDL）胆固醇，以及降糖治疗的变化。

结果

平均（标准差）基线 BMI 为 50.3（6.3）kg/m²，HbA1c 为 65.3（18.5）mmol/mol，收缩压为 146.0（18.0）mmHg，舒张压为 87.0（10.8）mmHg，总胆固醇与高密度脂蛋白胆固醇比值为 4.0（1.2）。BMI 平均（95%置信区间）降低 16.4（14.1-18.7）kg/m²，HbA1c 降低 23.6（17.6-29.6）mmol/mol，收缩压降低 12.9（5.9-19.8）mmHg，舒张压降低 6.1（1.8-10.5）mmHg，总胆固醇与高密度脂蛋白胆固醇比值降低 1.1（0.6-1.5），24 个月时所有指标均低于 0.001（P<0.001）。尽管 91%的患者术前正在接受降糖治疗，但术后 2 年有 62.1%和 5.2%的患者完全（HbA1c<42mmol/mol）和部分（HbA1c 42-48mmol/mol）缓解 T2D。