Lebovitz H E, Ludvik B, Yaniv I, Schwartz T, Zelewski M, Gutterman D D
State University of New York Health Science Center at Brooklyn, Staten Islands, New York, USA.
Medical University of Vienna, Internal Medicine: Vienna, Austria.
Horm Metab Res. 2015 Jun;47(6):456-62. doi: 10.1055/s-0035-1548944. Epub 2015 Apr 16.
The objectives of the present work are to evaluate long-term benefit of nonexcitatory gastric electrical stimulation (GES) by the DIAMOND(®) device on glycemic control and body weight in patients with type 2 diabetes inadequately controlled with oral agents and to determine the magnitude of the modulating effects of fasting plasma triglyceride (FTG) levels on these effects of GES. Sixty one patients with type 2 diabetes [HbA1c > 7.0% (53 mmol/mol) to < 10.5% (91 mmol/mol)] were implanted with the DIAMOND(®) GES device and treated with meal-mediated antral electrical stimulation for up to 36 months. The effects of baseline HbA1c and FTG on glycemic control, body weight, and systolic blood pressure were measured. GES reduced mean HbA1c by 0.9% and body weight by 5.7%. The effects were greater in patients with normal fasting plasma triglycerides (NTG) as compared to those with hypertriglyceridemia. The mean decrease in HbA1c in patients with NTG averaged 1.1% and was durable over 3 years of follow-up. ANCOVA indicated that improvement in HbA1c was a function of both baseline FTG group (p = 0.02) and HbA1c (p = 0.001) and their interaction (p = 0.01). Marked weight loss (≥ 10%) was observed in a significant proportion of NTG patients by 12 months of treatment and persisted through the 3 years. GES improves glycemic control and reduces body weight by a triglyceride-dependent mechanism in patients with type 2 diabetes inadequately controlled on oral agents. It is postulated that this is through a gut-brain interaction that modulates effects on the liver and pancreatic islets.
本研究的目的是评估DIAMOND（®）装置进行的非兴奋性胃电刺激（GES）对口服降糖药控制不佳的2型糖尿病患者血糖控制和体重的长期益处，并确定空腹血浆甘油三酯（FTG）水平对GES这些作用的调节效应大小。61例2型糖尿病患者[糖化血红蛋白（HbA1c）>7.0%（53 mmol/mol）至<10.5%（91 mmol/mol）]植入DIAMOND（®）GES装置，并接受进餐介导的胃窦电刺激治疗长达36个月。测量了基线HbA1c和FTG对血糖控制、体重和收缩压的影响。GES使平均HbA1c降低了0.9%，体重降低了5.7%。与高甘油三酯血症患者相比，空腹血浆甘油三酯正常（NTG）的患者效果更显著。NTG患者HbA1c的平均降低幅度为1.1%，且在3年随访期内持续存在。协方差分析表明，HbA1c的改善是基线FTG组（p = 0.02）、HbA1c（p = 0.001）及其相互作用（p = 0.01）的函数。治疗12个月时，相当比例的NTG患者出现显著体重减轻（≥10%），并持续至3年。GES通过甘油三酯依赖机制改善口服降糖药控制不佳的2型糖尿病患者的血糖控制并减轻体重。据推测，这是通过肠-脑相互作用调节对肝脏和胰岛的影响来实现的。
