Bhandari Mohit, Mathur Winni, Kumar Ravindra, Mishra Arun, Bhandari Mahak
Mohak Bariatrics and Robotics, Indore, India.
Central Research Laboratory, Sri Aurobindo Medical College and Post Graduate Institute, Indore, India.
Obes Surg. 2017 Dec;27(12):3267-3272. doi: 10.1007/s11695-017-2770-y.
Bariatric surgery, incretin-based therapy (glucagon-like peptide-1 analogues), and sodium-glucose co-transporter 2 (SGLT2) inhibitors have antidiabetic properties in morbidly obese patients. However, their comparative efficacy in treating type 2 diabetes mellitus (T2DM) in class I obese patients specifically in Indian has not been studied yet. This study evaluates and compares the efficacy and side effect of surgical and advanced medical management of T2DM in class I obese patients.
T2DM patients with body mass index ranging from 30 to 35 kg/m and with a median duration of 3 years and HbA1c level >7.5% were recruited for the study. Selection of treatment option that is bariatric surgery, GLP-1 analogues and SGLT2 inhibitor, was kept on patient's choice. Each group had 30 patients after 12 months of follow-up. Fasting plasma glucose (FPG), HbA1c, and lipid profile levels were assessed at baseline and after 12 months of follow-up.
There was statistically significant lowering of HbA1c and FPG after 12 months in all the three groups. However, this lowering was clinically insignificant in GLP-1 and SGLT2 groups. There was also improvement in lipid profile values in all the three groups with significantly higher percentage change in bariatric surgery group when compared to other modalities.
Bariatric surgery is a safe and effective procedure to treat T2DM in class I obese patients. It is also superior to advance medical treatment modalities such as GLP-1 analogues and SGLT2 inhibitors.
减肥手术、基于肠促胰岛素的疗法（胰高血糖素样肽-1类似物）和钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂在病态肥胖患者中具有抗糖尿病特性。然而，它们在治疗I类肥胖患者（特别是印度患者）的2型糖尿病（T2DM）方面的比较疗效尚未得到研究。本研究评估并比较了I类肥胖患者T2DM的手术治疗和先进药物治疗的疗效及副作用。
招募体重指数在30至35kg/m²之间、中位病程为3年且糖化血红蛋白水平>7.5%的T2DM患者进行研究。治疗方案的选择，即减肥手术、GLP-1类似物和SGLT2抑制剂，由患者自行决定。随访12个月后，每组有30名患者。在基线和随访12个月后评估空腹血糖（FPG）、糖化血红蛋白和血脂水平。
所有三组在12个月后糖化血红蛋白和FPG均有统计学意义的降低。然而，在GLP-1和SGLT2组中，这种降低在临床上无显著意义。所有三组的血脂水平也有改善，与其他方式相比，减肥手术组的百分比变化显著更高。
减肥手术是治疗I类肥胖患者T2DM的一种安全有效的方法。它也优于GLP-1类似物和SGLT2抑制剂等先进的药物治疗方式。
