Wentworth John M, Cheng Chloe, Laurie Cheryl, Skinner Stewart, Burton Paul R, Brown Wendy A, O'Brien Paul E
Monash University Centre for Obesity Research and Education, Melbourne, VIC, Australia.
Walter and Eliza Hall Institute, Parkville, VIC, Australia.
Obes Surg. 2018 Apr;28(4):982-989. doi: 10.1007/s11695-017-2944-7.
Long-term outcome data are needed to define the role of bariatric surgery in type 2 diabetes (T2D). To address this, we collated diabetes outcomes more than a decade after laparoscopic adjustable gastric band (LAGB) surgery.
Clinical and biochemical measures from 113 obese T2D patients who underwent LAGB surgery in 2003 and 2004 were analyzed. Diabetes remission was defined as HbA1c < 6.2% (44 mmol/mol) and fasting glucose < 7.0 mmol/L.
Seventy-nine patients had weight data at 10 years and attained a median [Q1, Q3] weight loss of 16 [10, 21] percent. Sixty patients attended a follow-up assessment. Their baseline HbA1c of 7.8 [7.1, 9.3] percentage units (62 [54, 78] mmol/mol) had decreased to 6.6 [6.1, 8.4] (49 [43, 68] mmol/mol) despite no significant change in glucose-lowering therapy. Eleven patients (18%) were in diabetes remission and another 18 had HbA1c ≤ 6.5%. Significant improvements in physical measures of quality of life, blood pressure, and lipid profile were also observed but there was no change in the proportion of patients with albuminuria and a significant decline in estimated glomerular filtration rate. Twelve patients in the follow-up cohort (20%) required anti-reflux medication after surgery and 26 (43%) underwent gastric band revision surgery.
Weight loss for over 10 years after LAGB surgery delivers clinically meaningful improvements in HbA1c, blood pressure, lipids, and quality of life at the cost of a high rate of revision surgery and increased use of anti-reflux medication. These findings support the use of bariatric surgery as a long-term treatment for weight loss and wellbeing in patients with T2D.
Registered with the Australian Clinical trials registry as ACTRN12615000089538.
需要长期结果数据来确定减肥手术在2型糖尿病（T2D）中的作用。为解决这一问题，我们整理了腹腔镜可调节胃束带术（LAGB）术后十多年的糖尿病结局数据。
分析了2003年和2004年接受LAGB手术的113例肥胖T2D患者的临床和生化指标。糖尿病缓解定义为糖化血红蛋白（HbA1c）<6.2%（44 mmol/mol）且空腹血糖<7.0 mmol/L。
79例患者有10年的体重数据，体重减轻中位数[四分位间距1，四分位间距3]为16[10，21]%。60例患者接受了随访评估。尽管降糖治疗无显著变化，但他们的基线HbA1c从7.8[7.1，9.3]个百分点（62[54，78]mmol/mol）降至6.6[6.1，8.4]（49[43，68]mmol/mol）。11例患者（18%）糖尿病缓解，另有18例患者HbA1c≤6.5%。生活质量、血压和血脂谱的身体指标也有显著改善，但蛋白尿患者比例无变化，估计肾小球滤过率显著下降。随访队列中的12例患者（20%）术后需要抗反流药物治疗，26例患者（43%）接受了胃束带修复手术。
LAGB术后超过10年的体重减轻在HbA1c、血压、血脂和生活质量方面带来了具有临床意义的改善，但代价是修复手术率高和抗反流药物使用增加
