Lee Wei-Jei, Chong Keong, Lin Yu-Hung, Wei Jih-Hua, Chen Shu-Chun
Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Taoyuan, Taiwan,
Obes Surg. 2014 Sep;24(9):1552-62. doi: 10.1007/s11695-014-1344-5.
Bariatric surgery may be beneficial in mildly obese patients with poorly controlled diabetes. The optimal procedure to achieve diabetes remission is unknown. In 2011, we published the short-term results of a pilot study designed to evaluate the efficacy of diabetic control and the role of duodenal exclusion in mildly obese diabetic patients undergoing laparoscopic sleeve gastrectomy (SG) vs. a laparoscopic single anastomosis (mini-) gastric bypass (SAGB). This study analyzes the 5-year results and evaluates the incretin effect.
A double-blind randomized trial included 60 participants with a hemoglobin A1c (HbA1c) level higher than 7.5%, a body mass index (BMI) between 25 and 35 Kg/m(2), a C-peptide level ≥1.0 ng/mL, and a diagnosis of type 2 diabetes mellitus (T2DM) for at least 6 months. A SAGB with duodenal exclusion or a SG without duodenal exclusion was performed.
The 5-year results of the primary outcome were as an intention-to-treat analysis for HbA1c ≤6.5% without glycemic therapy. Assessments of the incretin effect and β cell function were performed at baseline and between 36 and 60 months. The patients were randomly assigned to SAGB (n = 30) and SG (n = 30). At 60 months, 18 participants (60%; 95% confidence interval (CI), 42 to 78%) in the SAGB group and nine participants (30%; 95% CI, 13 to 47%) in the SG group achieved the primary end points (odds ratio (OR), 0.3; 95% CI, 0.1 to 0.8%). The participants assigned to the SAGB procedure had a similar percentage of weight loss as the SG patients (22.8 ± 5.9 vs. 20.1 ± 5.3%; p > 0.05) but achieved a lower level of HbA1c (6.1 ± 0.7 vs. 7.1 ± 1.2 %; p < 0.05) than the SG patients. There was a significant increase in the incretin effect before and after surgery in both groups, but the SAGB group had a higher incretin effect than the SG group at 5 years.
In mildly obese patients with T2DM, SG is effective at improving glycemic control at 5 years, but SAGB was more likely to achieve better glycemic control than SG and had a higher incretin effect compared to SG.
减肥手术可能对糖尿病控制不佳的轻度肥胖患者有益。实现糖尿病缓解的最佳手术方式尚不清楚。2011年，我们发表了一项试点研究的短期结果，该研究旨在评估糖尿病控制的疗效以及十二指肠旷置在接受腹腔镜袖状胃切除术（SG）与腹腔镜单吻合（迷你）胃旁路术（SAGB）的轻度肥胖糖尿病患者中的作用。本研究分析了5年结果并评估了肠促胰岛素效应。
一项双盲随机试验纳入了60名参与者，他们的糖化血红蛋白（HbA1c）水平高于7.5%，体重指数（BMI）在25至35kg/m²之间，C肽水平≥1.0ng/mL，且诊断为2型糖尿病（T2DM）至少6个月。进行了带十二指肠旷置的SAGB或不带十二指肠旷置的SG手术。
主要结局的5年结果是对未接受降糖治疗的HbA1c≤6.5%进行意向性分析。在基线以及36至60个月之间对肠促胰岛素效应和β细胞功能进行了评估。患者被随机分配至SAGB组（n = 30）和SG组（n = 30）。在60个月时，SAGB组中有18名参与者（60%；95%置信区间（CI），42%至78%），SG组中有9名参与者（30%；95%CI，13%至47%）达到了主要终点（优势比（OR），0.3；95%CI，0.1至0.8%）。分配至SAGB手术的参与者的体重减轻百分比与SG患者相似（22.8±5.9 vs. 20.1±5.3%；p>0.05），但HbA1c水平低于SG患者（6.1±0.7 vs. 7.1±1.2%；p<0.05）。两组手术前后的肠促胰岛素效应均有显著增加，但SAGB组在5年时的肠促胰岛素效应高于SG组。
在轻度肥胖的T2DM患者中，SG在5年时可有效改善血糖控制，但SAGB比SG更有可能实现更好的血糖控制，且与SG相比具有更高的肠促胰岛素效应。
