Eickhoff Hans, Guimarães Ana, Louro Teresa M, Seiça Raquel M, Castro E Sousa Francisco
Obesity Center, Hospital de Santiago, EN 10, km 37, 2900-722, Setúbal, Portugal,
Surg Endosc. 2015 Feb;29(2):438-43. doi: 10.1007/s00464-014-3675-7. Epub 2014 Jul 4.
Pathophysiology of type 2 diabetes (T2D) includes insulin resistance (IR) and insufficient insulin secretion. Remission in obese patients can be achieved through surgically induced weight loss. Sleeve gastrectomy is a novel technique for the treatment of morbid obesity, and its effects on the metabolic syndrome and T2D have not yet been fully understood.
From February 2008 to July 2010, sleeve gastrectomy as stand-alone treatment for severe or morbid obesity was performed in 23 patients with T2D or impaired fasting glucose (IFG). No postoperative complications occurred and patients were dismissed from hospital on day 2 after surgery. Body mass index (BMI), fasting blood glucose (FBG) and fasting insulin were determined before and up to 24 months after surgery. IR and beta cell function were calculated using the modified homeostasis model assessment (HOMA2).
BMI, FBG and fasting insulin improved significantly as early as 3 months after surgery. Threefold increased preoperative insulin resistance (3.05) decreased to near-normal values (1.14) during the same period. Interestingly, overall beta cell function diminished at 12 months of follow-up (79.6 %), in comparison with preoperative values (117.8 %). Patients with a markedly reduced preoperative beta cell function (<40 %) did not achieve a complete remission after surgery.
In obese patients with T2D and IFG, commonly characterized by an augmented beta cell function and an increased insulin resistance, sleeve gastrectomy induces remission through reduction of insulin resistance. Preoperative IR and beta cell function calculated by HOMA2 deserve further studies in patients undergoing metabolic surgery.
2型糖尿病（T2D）的病理生理学包括胰岛素抵抗（IR）和胰岛素分泌不足。肥胖患者可通过手术诱导体重减轻实现病情缓解。袖状胃切除术是一种治疗病态肥胖的新技术，其对代谢综合征和T2D的影响尚未完全明确。
2008年2月至2010年7月，对23例T2D或空腹血糖受损（IFG）患者进行袖状胃切除术作为重度或病态肥胖的单独治疗。术后未发生并发症，患者术后第2天出院。在手术前及术后长达24个月测定体重指数（BMI）、空腹血糖（FBG）和空腹胰岛素。使用改良的稳态模型评估（HOMA2）计算IR和β细胞功能。
BMI、FBG和空腹胰岛素早在术后3个月就有显著改善。术前胰岛素抵抗增加了三倍（3.05），同期降至接近正常水平（1.14）。有趣的是，与术前值（117.8%）相比，随访12个月时总体β细胞功能下降（79.6%）。术前β细胞功能明显降低（<40%）的患者术后未实现完全缓解。
在以β细胞功能增强和胰岛素抵抗增加为共同特征的肥胖T2D和IFG患者中，袖状胃切除术通过降低胰岛素抵抗诱导病情缓解。术前通过HOMA2计算的IR和β细胞功能值得在接受代谢手术的患者中进一步研究。
