Aminian Ali, Brethauer Stacy A, Andalib Amin, Punchai Suriya, Mackey Jennifer, Rodriguez John, Rogula Tomasz, Kroh Matthew, Schauer Philip R
*Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH †Department of Surgery, Center for Bariatric Surgery, McGill University, Montreal, QC, Canada ‡University Hospitals, Case Western Reserve University, Cleveland, OH.
Ann Surg. 2016 Oct;264(4):674-81. doi: 10.1097/SLA.0000000000001857.
The aim of the study was to assess long-term metabolic effects of laparoscopic sleeve gastrectomy (LSG) in patients with type 2 diabetes (T2DM) and to identify predictive factors for long-term diabetes remission and relapse.
LSG has become the most common bariatric operation worldwide. Its long-term metabolic effects in patients with T2DM are, however, unknown.
Outcomes of 134 patients with obesity with T2DM who underwent LSG at an academic center during 2005 to 2010 and had at least 5 years of follow-up were assessed.
At a median postsurgical follow-up of 6 years (range: 5-9), a mean body mass index loss of -7.8 ± 5.1 kg/m (total weight loss: 16.8% ± 9.7%) was associated with a reduction in mean glycated hemoglobin (HbA1c, -1.3 ± 1.8%, P < 0.001), fasting blood glucose (-37.8 ± 70.4 mg/dL, P < 0.001) and median number of diabetes medications (-1, P < 0.001). Long-term glycemic control (HbA1c <7%) was seen in 63% of patients (vs 31% at baseline, P < 0.001), diabetes remission (HbA1c <6.5% off medications) in 26%, complete remission (HbA1c <6% off medications) in 11%, and "cure" (continuous complete remission for ≥5 years) was achieved in 3%. Long-term relapse of T2DM after initial remission occurred in 44%. Among patients with relapse, 67% maintained glycemic control (HbA1c <7%). On adjusted analysis, taking 2 or more diabetes medications at baseline predicted less long-term remission (odds ratio 0.19, 95% confidence interval 0.07-0.55, P = 0.002) and more relapse of T2DM (odds ratio 8.50, 95% confidence interval: 1.40-49.20, P = 0.02). Significant improvement in triglycerides (-53.7 ± 116.4 mg/dL, P < 0.001), high-density lipoprotein (8.2 ± 12.9 mg/dL, P < 0.001), systolic (-8.9 ± 18.7 mmHg, P < 0.001) and diastolic blood pressure (-2.6 ± 14.5 mmHg, P = 0.04), and cardiovascular risk (13% relative reduction, P < 0.001) was observed.
LSG can significantly improve cardiometabolic risk factors including glycemic status in T2DM. Long-term complete remission and "cure" of T2DM, however, occur infrequently.
本研究旨在评估腹腔镜袖状胃切除术（LSG）对2型糖尿病（T2DM）患者的长期代谢影响，并确定长期糖尿病缓解和复发的预测因素。
LSG已成为全球最常见的减肥手术。然而，其对T2DM患者的长期代谢影响尚不清楚。
评估了2005年至2010年期间在一家学术中心接受LSG且至少随访5年的134例肥胖合并T2DM患者的结局。
术后中位随访6年（范围：5 - 9年），平均体重指数下降-7.8±5.1kg/m²（总体重减轻：16.8%±9.7%），同时糖化血红蛋白平均降低（HbA1c，-1.3±1.8%，P < 0.001）、空腹血糖降低（-37.8±70.4mg/dL，P < 0.001）以及糖尿病药物使用中位数减少（-1，P < 0.001）。63%的患者实现了长期血糖控制（HbA1c < 7%，与基线时的31%相比，P < 0.001），26%的患者糖尿病缓解（停药后HbA1c < 6.5%），11%的患者完全缓解（停药后HbA1c < 6%），3%的患者实现了“治愈”（持续完全缓解≥5年）。初始缓解后T2DM的长期复发率为44%。在复发患者中，67%维持了血糖控制（HbA1c < 7%）。经校正分析，基线时服用2种或更多糖尿病药物可预测长期缓解率较低（优势比0.19，95%置信区间0.07 - 0.55，P = 0.002）以及T2DM复发率较高（优势比8.50，95%置信区间：1.40 - 49.20，P = 0.02）。甘油三酯（-53.7±116.4mg/dL，P < 0.001）、高密度脂蛋白（8.2±12.9mg/dL，P < 0.001）、收缩压（-8.9±18.7mmHg，P < 0.001）和舒张压（-2.6±14.5mmHg，P = 0.04）以及心血管风险（相对降低13%，P < 0.001）均有显著改善。
LSG可显著改善包括T2DM患者血糖状态在内的心脏代谢危险因素。然而，T2DM的长期完全缓解和“治愈”情况并不常见。
