Chuah Ling L, Miras Alexander D, Papamargaritis Dimitris, Jackson Sabina N, Olbers Torsten, le Roux Carel W
Metabolic Medicine Research Unit, Imperial College London, United Kingdom.
Metabolic Medicine Research Unit, Imperial College London, United Kingdom.
Surg Obes Relat Dis. 2015 May-Jun;11(3):578-84. doi: 10.1016/j.soard.2014.11.004. Epub 2014 Nov 13.
Roux-en-Y gastric bypass (RYGB) surgery is associated with rapid postsurgical improvement in glycemic control in patients with type 2 diabetes mellitus (T2 DM). However, there is little outcome-based evidence to guide the glycemic management of this patient group preoperatively.
We conducted 2 pilot studies randomizing patients to assess the impact of intensive glucose management pre- and post-RYGB on clinical outcomes after surgery.
University hospital.
In the GLUCOSURG-pre randomized controlled trial (RCT), 34 obese T2 DM patients with glycated hemoglobin (HbA1 c) ≥8.5% (69 mmol/mol) undergoing RYGB were randomly assigned to receive either glucose optimization or no optimization 3 months preoperatively. In the GLUCOSURG-post RCT, 35 obese T2 DM patients on insulin were randomly assigned to either intensive or conservative glucose management up to 2 weeks post- RYGB. HbA1c at 1 year post-RYGB was the primary outcome.
In GLUCOSURG-pre, the HbA1 c at 1 year postsurgery was -3.0% (51.9 mmol/mol) in the optimized and -4.0% (45.4 mmol/mol) in the nonoptimized groups (P = .06). In GLUCOSURG-post, there were no significant differences in HbA1 c at 1 year postsurgery between the intensive and conservative groups [-2.4% (44.3 mmol/mol)] versus [-2.3% (44.3 mmol/mol), P = .73)].
Our pilot studies suggested that neither intensive management of glycemia in the 3 months pre- RYGB, nor the first 2 weeks post-RYGB resulted in better glycemic control one year after surgery. RYGB has substantial effects on glucose control, and additional intensive glucose-lowering interventions do not confer clinical benefits compared to conservative approaches.
Roux-en-Y胃旁路术（RYGB）与2型糖尿病（T2 DM）患者术后血糖控制的快速改善相关。然而，基于结果的证据很少，无法指导该患者群体术前的血糖管理。
我们进行了两项试点研究，将患者随机分组，以评估RYGB术前和术后强化血糖管理对术后临床结局的影响。
大学医院。
在GLUCOSURG-pre随机对照试验（RCT）中，34例糖化血红蛋白（HbA1c）≥8.5%（69 mmol/mol）的肥胖T2 DM患者接受RYGB，被随机分配在术前3个月接受血糖优化或不进行优化。在GLUCOSURG-post RCT中，35例使用胰岛素的肥胖T2 DM患者被随机分配在RYGB术后长达2周接受强化或保守血糖管理。RYGB术后1年的HbA1c是主要结局。
在GLUCOSURG-pre中，优化组术后1年的HbA1c为-3.0%（51.9 mmol/mol），未优化组为-4.0%（45.4 mmol/mol）（P = 0.06）。在GLUCOSURG-post中，强化组和保守组术后1年的HbA1c无显著差异[-2.4%（44.3 mmol/mol）对[-2.3%（44.3 mmol/mol），P = 0.73]。
我们的试点研究表明，RYGB术前3个月的强化血糖管理和术后前2周的强化血糖管理均未使术后1年的血糖控制更好。RYGB对血糖控制有显著影响，与保守方法相比，额外的强化降糖干预未带来临床益处。
