Dicker Dror, Yahalom Rina, Comaneshter Doron S, Vinker Shlomo
Department of Internal Medicine D, Hasharon Hospital, Rabin Medical Center, 7 Keren Kayemet St., Petah Tikva, Israel, 49100.
Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
Obes Surg. 2016 Aug;26(8):1814-20. doi: 10.1007/s11695-015-2025-8.
Different bariatric surgeries have demonstrated different effectiveness for weight loss and glucose control in obese persons with diabetes, over a short follow-up time. The aim of this study was to compare weight loss, glucose control, and diabetes remission in individuals with type 2 diabetes, after three types of bariatric surgery: gastric banding (GB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB), with 5 years follow-up.
A retrospective study was conducted on bariatric surgeries performed during 2002-2011 in a large nationwide healthcare organization.
Of 2190 patients, 64.8 % were women. The operations performed were 1027 GB, 1023 SG, and 140 RYGB. Mean BMI ± SD at baseline, 1 year postoperatively, and 5 years postoperatively were 43.5 ± 6.18, 37.1 ± 6.35, and 35.5 ± 6.48 for GB; 43.6 ± 6.42, 34.4 ± 6.08, and 35.3 ± 6.7 for SG; and 42.8 ± 5.81, 32.8 ± 4.9, and 34.1 ± 5.09 for RYGB. Mean HbA1c ± SD at baseline, 1 year postoperatively, and 5 years postoperatively were 7.6 + 1.58, 6.5 + 1.22, and 6.8 + 1.48 for GB; 7.7 + 1.63, 6.4 + 1.18, and 6.7 + 1.57 for SG; and 8.0 + 1.78, 6.3 + 0.98, and 7.04 + 1.42 for RYGB. At 1 year follow-up, 53.2 % had achieved remission; at 5 years, 54.4 %. Remission rates at 5 years were similar for the three surgeries. Five-year remission was inversely associated with baseline HbA1c and with treatment with insulin at baseline and positively associated with BMI.
For all three surgeries, diabetes remission was higher than the baseline after 5 years; mean BMI and HbA1c decreased considerably during the first year postoperatively and remained lower than basal values throughout follow-up. Early improvements were greatest for RYGB, though the advantage over the other operations diminished with time.
在较短的随访期内，不同的减肥手术对肥胖糖尿病患者的体重减轻和血糖控制显示出不同的效果。本研究的目的是比较三种减肥手术（胃束带术（GB）、袖状胃切除术（SG）和Roux-en-Y胃旁路术（RYGB））后2型糖尿病患者的体重减轻、血糖控制及糖尿病缓解情况，并进行5年随访。
对2002年至2011年在一个大型全国性医疗保健机构进行的减肥手术进行回顾性研究。
2190例患者中，64.8%为女性。实施的手术包括1027例GB、1023例SG和140例RYGB。GB组患者基线、术后1年和术后5年的平均体重指数（BMI）±标准差分别为43.5±6.18、37.1±6.35和35.5±6.48；SG组分别为43.6±6.42、34.4±6.08和35.3±6.7；RYGB组分别为42.8±5.81、32.8±4.9和34.1±5.09。GB组患者基线、术后1年和术后5年的平均糖化血红蛋白（HbA1c）±标准差分别为7.6 + 1.58、6.5 + 1.22和6.8 + 1.48；SG组分别为7.7 + 1.63、6.4 + 1.18和6.7 + 1.57；RYGB组分别为8.0 + 1.78、6.3 + 0.98和7.04 + 1.42。随访1年时，53.2%的患者实现缓解；随访5年时，这一比例为54.4%。三种手术的5年缓解率相似。5年缓解率与基线HbA1c、基线胰岛素治疗呈负相关，与BMI呈正相关。
对于所有三种手术，5年后糖尿病缓解率均高于基线水平；术后第一年平均BMI和HbA1c显著下降，且在整个随访期内均低于基础值。RYGB术后早期改善最为明显，不过随着时间推移，其相对于其他手术的优势逐渐减弱。
