Scopinaro Nicola, Adami Gian Franco, Bruzzi Paolo, Cordera Renzo
Department of Surgery, IRCCS San Martino and Università di Genova, Genoa, Italy.
Department of Endocrinology, IRCCS San Martino and Università di Genova, Genoa, Italy.
Obes Surg. 2017 Jul;27(7):1705-1708. doi: 10.1007/s11695-017-2555-3.
In obese patients with type 2 diabetes (T2DM), the marked weight loss following bariatric surgery is accompanied in a consistent number of cases by T2DM resolution or control. The clinical need of preoperative parameters reliable in predicting a positive metabolic outcome at long term following the operation has then emerged.
A cohort of 135 consecutive T2DM patients with a wide range of body mass index (BMI) at more than 5 years following biliopancreatic diversion (BPD) was considered. The 5-year-T2DM resolution, defined as glycosylated hemoglobin (HbA1) lower than 6.5% without antidiabetic therapy, was related to demographic, anthropometric, and biochemical findings prior to the operation. The long-term metabolic outcome was positively related to baseline BMI values and negatively with the preoperative use of insulin.
BMI and insulin therapy at the time of surgery are associated with the probability of T2DM long lasting remission and could be used as solid predictors before surgery. In the overweight and non morbidly obese diabetic patients, bariatric surgery is less efficient in determining long term T2DM resolution than in their morbid obese counterparts.
在肥胖的2型糖尿病（T2DM）患者中，减肥手术后显著的体重减轻在一定数量的病例中伴随着T2DM的缓解或得到控制。于是出现了对术前参数的临床需求，这些参数能可靠地预测术后长期的积极代谢结果。
研究了一组135例接受胆胰分流术（BPD）超过5年、体重指数（BMI）范围广泛的连续性T2DM患者。5年T2DM缓解定义为在未接受抗糖尿病治疗的情况下糖化血红蛋白（HbA1）低于6.5%，其与手术前的人口统计学、人体测量学和生化指标相关。长期代谢结果与基线BMI值呈正相关，与术前胰岛素使用呈负相关。
手术时的BMI和胰岛素治疗与T2DM长期缓解的可能性相关，可作为手术前可靠的预测指标。在超重和非病态肥胖的糖尿病患者中，减肥手术在实现T2DM长期缓解方面比病态肥胖患者的效果要差。
