Zenti Maria Grazia, Rubbo Ilaria, Ceradini Giulia, Rinaldi Elisabetta, Nadalini Luisa, Battistoni Marco, Genna Michele, Bonora Enzo, Zoppini Giacomo
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, UOC Endocrinologia, University and University Hospital of Verona, Piazzale Stefani 1, 37126, Verona, Italy.
USD Clinical Psychology, Department of Medicine, University Hospital of Verona, Verona, Italy.
Acta Diabetol. 2015 Oct;52(5):937-42. doi: 10.1007/s00592-015-0738-8. Epub 2015 Mar 27.
The aims of the study were to investigate weight loss and glycemic control parameters after different bariatric surgical procedures in type 2 diabetes (T2D) obese patients and identify patients' factors that predict diabetes remission.
The study included 105 obese T2D patients (66 women and 39 men) who underwent laparoscopic gastric banding (LAGB, 11 subjects, age 47 ± 10 years, BMI 42.3 ± 8.3 kg/m(2)), or laparoscopic Roux-en-Y gastric bypass (RYBP, 77 subjects, age 50 ± 8 years, BMI 45.7 ± 6.8 kg/m(2)), or sleeve gastrectomy (SG, 17 subjects, age 49 ± 11 years, BMI 50.2 ± 8.8 kg/m(2)) during 2005-2012 period.
The average percentage of weight loss at 12 months after surgery was 26.4 ± 9.8 %, and it was maintained at 24 and 36 months of follow-up. Diabetes remission occurred in 68.6 % of study participants (4/11 of LAGB, 54/77 of RYBP and 14/17 of SG). In multivariate Cox analysis, age, duration of diabetes, surgical procedure and glycated hemoglobin <53 mmol/mol (7 %) resulted significant predictors of diabetes remission (age RR = 0.97, 95 %CI 0.94-1.0, p = 0.05; diabetes duration RR = 0.93, 95 % CI 0.86-0.99, p = 0.036; rif LAGB, RYBP RR = 3.9, 95 % CI 1.31-11.57, p = 0.014; SG RR = 5.6, 95 % CI 1.67-18.64, p = 0.005; glycated hemoglobin RR = 0.54, 95 % CI 0.32-0.92, p = 0.024).
Bariatric surgical procedures that modify the upper gastrointestinal tract anatomy (RYBP and SG) are more successful in producing weight loss and remission of T2D than those that simply restrict stomach capacity (LAGB). Younger age, short duration of diabetes and better glucose control confer higher probability of achieving remission of diabetes.
本研究旨在调查2型糖尿病（T2D）肥胖患者在接受不同减肥手术后的体重减轻情况和血糖控制参数，并确定预测糖尿病缓解的患者因素。
该研究纳入了105例肥胖的T2D患者（66例女性和39例男性），他们在2005年至2012年期间接受了腹腔镜胃束带术（LAGB，11例，年龄47±10岁，BMI 42.3±8.3kg/m²）、腹腔镜Roux-en-Y胃旁路术（RYBP，77例，年龄50±8岁，BMI 45.7±6.8kg/m²）或袖状胃切除术（SG，17例，年龄49±11岁，BMI 50.2±8.8kg/m²）。
术后12个月体重减轻的平均百分比为26.4±9.8%，并在随访的24个月和36个月时保持。68.6%的研究参与者出现糖尿病缓解（LAGB组4/11，RYBP组54/77，SG组14/17）。在多变量Cox分析中，年龄、糖尿病病程、手术方式和糖化血红蛋白<53 mmol/mol（7%）是糖尿病缓解的显著预测因素（年龄RR = 0.97，95%CI 0.94-1.0，p = 0.05；糖尿病病程RR = 0.93，95%CI 0.86-0.99，p = 0.036；与LAGB相比，RYBP RR = 3.9，95%CI 1.31-11.57，p = 0.014；SG RR = 5.6，95%CI 1.67-18.64，p = 0.005；糖化血红蛋白RR = 0.54，95%CI 0.32-0.92，p = 0.024）。
改变上消化道解剖结构的减肥手术（RYBP和SG）在减轻体重和缓解T2D方面比单纯限制胃容量的手术（LAGB）更成功。年龄较小、糖尿病病程较短和血糖控制较好的患者实现糖尿病缓解的可能性更高。
