Robert Maud, Belanger Pascale, Hould Frédéric Simon, Marceau Simon, Tchernof André, Biertho Laurent
Department of Surgery, Division of Bariatric and General Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada; Hospices civils de Lyon, Université Lyon I, France..
Department of Nutrition, Laval University, Quebec, Canada.
Surg Obes Relat Dis. 2015 Jul-Aug;11(4):798-805. doi: 10.1016/j.soard.2014.12.016. Epub 2014 Dec 24.
Bariatric surgery has recently been endorsed as an effective treatment of type 2 diabetes (T2D) in severely obese patients. Little is known about its metabolic effects in type 1 diabetes (T1D). The objectives were to assess bariatric surgery outcomes in T1D obese patients who underwent either a biliopancreatic diversion (BPD) or a sleeve gastrectomy (SG) and who were matched with T2D obese patients requiring insulin therapy. The study setting was at a university-affiliated tertiary care center.
Through retrospective analysis of prospectively collected data, ten patients with T1D (7 BPD, 3 SG) were matched with 20 patients with T2D (14 BPD, 6 SG) according to age, gender, type of surgery, initial Body Mass Index and insulin requirements (1:2 matching). Weight loss, diabetes control, and remission of co-morbidities were compared.
Mean follow-up was 55.1 months. Mean Excess BMI Loss% tended to be greater in T1D patients compared to T2D (77.1% versus 68.3%, P = .14). The remission and improvement rates of T2D were 55% and 45% versus 0% and 90% for T1D. The remission rate of T2D was significantly greater after BPD (71.43%) compared to SG (16.67%, P = .04). Insulin requirements were significantly reduced in both groups after surgery (T1D: .44 ±.24 versus 1.09 ±.7 units/kg/d, P = 0.03, T2D: .03 ±.12 versus .89 ±.77 units/kg/d, P = .0001). Remission rates of hypertension and dyslipidemia were similar for T1D and T2D (66.7% versus 62.5%, P = .63 and 88.9% versus 75%, P = .23).
Even if metabolic surgery has limited effect on glycemic control in T1D, it improves insulin sensitivity and other co-morbidities. It should be considered as a therapeutic option in selected obese patients with metabolic syndrome and high cardio-vascular risk.
减重手术最近已被认可为重度肥胖患者2型糖尿病（T2D）的有效治疗方法。关于其在1型糖尿病（T1D）中的代谢作用知之甚少。目的是评估接受胆胰分流术（BPD）或袖状胃切除术（SG）的T1D肥胖患者以及与需要胰岛素治疗的T2D肥胖患者相匹配的减重手术结果。研究地点为一所大学附属的三级医疗中心。
通过对前瞻性收集的数据进行回顾性分析，根据年龄、性别、手术类型、初始体重指数和胰岛素需求（1:2匹配），将10例T1D患者（7例BPD，3例SG）与20例T2D患者（14例BPD，6例SG）进行匹配。比较体重减轻、糖尿病控制情况以及合并症的缓解情况。
平均随访时间为55.1个月。与T2D患者相比，T1D患者的平均超重体重指数降低百分比往往更高（77.1%对68.3%，P = 0.14）。T2D的缓解率和改善率分别为55%和45%，而T1D为0%和90%。与SG（16.67%，P = 0.04）相比，BPD后T2D的缓解率显著更高（71.43%）。两组患者术后胰岛素需求均显著降低（T1D：0.44±0.24对1.09±0.7单位/千克/天，P = 0.03；T2D：0.03±0.12对0.89±0.77单位/千克/天，P = .0001）。T1D和T2D的高血压和血脂异常缓解率相似（66.7%对62.5%，P = 0.63；88.9%对75%，P = 0.23）。
即使代谢手术对T1D患者的血糖控制效果有限，但它能改善胰岛素敏感性和其他合并症。对于选定的患有代谢综合征和高心血管风险的肥胖患者，应将其视为一种治疗选择。
