Obesity Unit, Hospital Clinic Universitari, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer, Barcelona, Spain.
Obesity Unit, Hospital Clinic Universitari, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Barcelona, Spain.
Surg Obes Relat Dis. 2017 Dec;13(12):2004-2009. doi: 10.1016/j.soard.2016.12.030. Epub 2016 Dec 31.
To assess the extent and durability of the glucose-lowering effect of bariatric surgery (BS) in patients with insulin-treated type 2 diabetes mellitus (T2D).
Even though BS in patients with insulin-treated T2D is likely to increase, data on the midterm effect of Roux-en-Y gastric bypass and sleeve gastrectomy in this group of patients are scant.
University hospital.
Prospective observational study (4.9±1.9 yr) on T2D outcomes, changes in hemoglobin A1C (HbA1C), and diabetes therapy in individuals with insulin-treated T2D undergoing Roux-en-Y gastric bypass (n = 24) or sleeve gastrectomy (n = 50).
Diabetes remission was initially observed in 20 of 74 individuals, but relapse occurred in 13 of the 20 (65.0%) patients. Overall, marked initial reduction of HbA1C and high rates of insulin cessation were observed (HbA1C nadir 5.9%±0.9%, insulin cessation rate 66.2%). However, these were followed by progressive deterioration of HbA1C (HbA1C at last follow-up 7.4%±1.3%; P<.001) and need for insulin therapy reintroduction (rate of insulin cessation at last follow-up visit 54%; P = .04). In multivariate analysis, larger maximum percent excess weight loss and nonbasal bolus insulin therapy were identified as significant predictors of diabetes remission, insulin cessation, and durability of HbA1C<7%.
In insulin-treated patients with T2DM, BS is associated with a low likelihood of midterm diabetes remission. Overall, in this group of patients, the marked initial improvement of glycemic control and insulin independence are of limited durability. In addition, in this group of patients, the need for prandrial insulin and lower postsurgical weight loss may hamper the beneficial effects of BS on glycemic control.
评估减重手术（BS）对接受胰岛素治疗的 2 型糖尿病（T2D）患者降低血糖效果的程度和持久性。
尽管接受胰岛素治疗的 T2D 患者的 BS 可能会增加，但关于 Roux-en-Y 胃旁路术和袖状胃切除术在该组患者中的中期效果的数据很少。
大学医院。
对接受 Roux-en-Y 胃旁路术（n = 24）或袖状胃切除术（n = 50）的胰岛素治疗 T2D 个体的 T2D 结局、血红蛋白 A1C（HbA1C）变化和糖尿病治疗进行前瞻性观察研究（4.9±1.9 年）。
最初有 20 例 74 例患者中的 20 例患者出现糖尿病缓解，但其中 13 例（65.0%）患者出现缓解。总体而言，观察到 HbA1C 的显著初始降低和高胰岛素停药率（HbA1C 最低值 5.9%±0.9%，胰岛素停药率 66.2%）。然而，随后 HbA1C 逐渐恶化（HbA1C 最后随访时为 7.4%±1.3%；P<.001），需要重新引入胰岛素治疗（最后随访时胰岛素停药率为 54%；P =.04）。在多变量分析中，更大的最大超体重损失百分比和非基础胰岛素冲击治疗被确定为糖尿病缓解、胰岛素停药和 HbA1C<7%的持久性的显著预测因素。
在接受胰岛素治疗的 T2DM 患者中，BS 与中期糖尿病缓解的可能性较低相关。总体而言，在这组患者中，血糖控制和胰岛素独立性的显著初始改善具有有限的持久性。此外，在这组患者中，餐前胰岛素和术后体重减轻较少的需求可能会阻碍 BS 对血糖控制的有益效果。
