Beleigoli Alline Maria Rezende, Coelho Ana Luisa Bittencourt, Diniz Marco Túlio Costa, Lages Savassi-Rocha Alexandre, Diniz Maria de Fátima Haueisen Sander
Departamento de Clínica Médica; Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil.
Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil.
Surg Obes Relat Dis. 2014 Nov-Dec;10(6):1022-7. doi: 10.1016/j.soard.2014.08.016. Epub 2014 Sep 6.
It is not widely known whether glycemic control (GC) is sustained after Roux-en-Y gastric bypass (RYGB). The objective of this study was to investigate incidence and remission of type 2 diabetes mellitus (T2DM) among 284 individuals with body mass index (BMI)≥35 kg/m(2) at operation (1998-2011) through 2013.
Baseline GC was based on fasting glycemia (FG), hemoglobin A1c (HbA1c), and medication. Incident T2DM, complete (normal GC/HbA1c) and partial (abnormal FG/A1c) remission at the last follow-up visit, and relapse were the outcomes of interest. Kaplan-Meier curves and log-rank tests were used to compare time to improvement according to insulin use and HbA1c levels at baseline. Pre- and postoperative determinants of T2DM improvement were investigated by logistic regression.
Participants were predominantly female (220; 77.2%) with mean age of 39.6 (10.5) years and median BMI of 51.9 (46.1-57.5) kg/m(2) at operation. The mean follow-up time was 5.1 (3.2) years with 67.5% (55.0-78.4) of excess BMI loss (EBL) at the 5(th) year. Normal GC, abnormal FG, and T2DM were observed in 169 (59.5%), 32 (11.2%), and 83 (29.3%) participants at baseline, respectively. The 7 (4.1%) patients with incident T2DM had lower BMI at baseline than those who remained with normal GC (43.6 kg/m(2) [42.0-50.8] versus 52.1 kg/m(2) [46.7-57.7]; P = .01). Complete and partial T2DM remission occurred in 61 (61.3%) and 5 (6.7%) participants, respectively. Baseline HbA1c was associated with a significant difference in the proportion of cases with remission at the 5(th) year of follow-up (P = .016). Age (OR .83; 95% CI .72-.95) and % EBL at the 2(nd) year of follow-up (OR 1.05; 95% CI 1.01-1.09) were independent determinants of T2DM improvement. Relapse occurred in 14 (14.3%) cases.
We observed a low incidence and impressive improvement rates of T2DM after intermediate follow-up of RYGB.
Roux-en-Y胃旁路术（RYGB）后血糖控制（GC）是否能持续，目前尚不广为人知。本研究的目的是调查284例手术时体重指数（BMI）≥35 kg/m²（1998 - 2011年）的个体至2013年2型糖尿病（T2DM）的发病率及缓解情况。
基线GC基于空腹血糖（FG）、糖化血红蛋白（HbA1c）及用药情况。新发T2DM、末次随访时完全（正常GC/HbA1c）和部分（异常FG/A1c）缓解以及复发是研究关注的结果。采用Kaplan-Meier曲线和对数秩检验，根据胰岛素使用情况和基线HbA1c水平比较改善时间。通过逻辑回归研究T2DM改善的术前和术后决定因素。
参与者以女性为主（220例；77.2%），手术时平均年龄为39.6（10.5）岁，BMI中位数为51.9（46.1 - 57.5）kg/m²。平均随访时间为5.1（3.2）年，第5年多余体重减轻（EBL）为67.5%（55.0 - 78.4）。基线时，169例（59.5%）参与者GC正常，32例（11.2%）FG异常，83例（29.3%）患有T2DM。7例（4.1%）新发T2DM患者基线BMI低于GC仍正常者（43.6 kg/m² [42.0 - 50.8] 对52.1 kg/m² [46.7 - 57.7]；P = 0. 01）。分别有61例（61.3%）和5例（6.7%）参与者实现了T2DM的完全和部分缓解。基线HbA1c与随访第5年缓解病例比例的显著差异相关（P = 0.016）。年龄（比值比0.83；95%置信区间0.72 - 0.95）和随访第2年的EBL百分比（比值比1.05；95%置信区间1.01 - 1.09）是T2DM改善的独立决定因素。14例（14.3%）出现复发。
我们观察到RYGB中期随访后T2DM发病率较低且改善率令人印象深刻。
