Diabetes Surgery Centre, General Surgery Department, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University).
Biosci Trends. 2017;11(6):675-681. doi: 10.5582/bst.2017.01307.
Our purpose was to explore the remission of insulin resistance after bariatric surgery to discover the mechanism of diabetes remission excluding dietary factors. A retrospective case control study was conducted on patients with type 2 diabetes, who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic gastric bypass surgery (LGB) in Beijing Shijitan Hospital from April 1, 2012 to April 1, 2013. The laboratory and anthropometric data was analyzed pre-surgery and during a 2-year follow-up. HOMA-IR was calculated and evaluated. The two surgical procedures were compared. No significant difference in complete remission rate was observed between the two groups (LGB group: 62.1%, LSG group: 60.0%, p = 0.892). HOMA-IR was reduced to a stable level at the 3 month after surgery. The cut-off value of HOMA-IR was 2.38 (sensitivity: 0.938, specificity: 0.75) and 2.33 (sensitivity: 0.941, specificity: 0.778) respectively for complete remission after LSG or LGB surgery. Insulin resistance was improved while GLP-1 and Ghrelin was changed significantly in patients with type 2 diabetes prior to weight loss either in the LSG or LGB group. HOMA-IR decreased to less than the cut-off value at the 3 month and was closely related to complete remission. The mechanism of bariatric surgery was not due just to simply dietary factors or body weight loss but also the remission of insulin resistance.
我们的目的是探索减重手术后胰岛素抵抗的缓解情况，以发现除饮食因素外糖尿病缓解的机制。对 2012 年 4 月 1 日至 2013 年 4 月 1 日在北京世纪坛医院接受腹腔镜袖状胃切除术（LSG）或腹腔镜胃旁路手术（LGB）的 2 型糖尿病患者进行了回顾性病例对照研究。分析了术前和 2 年随访期间的实验室和人体测量学数据。计算并评估了 HOMA-IR。比较了两种手术程序。两组之间完全缓解率无显著差异（LGB 组：62.1%，LSG 组：60.0%，p=0.892）。HOMA-IR 在术后 3 个月降至稳定水平。HOMA-IR 的截断值分别为 2.38（灵敏度：0.938，特异性：0.75）和 2.33（灵敏度：0.941，特异性：0.778），用于 LSG 或 LGB 手术后完全缓解。无论在 LSG 还是 LGB 组，体重减轻前的 2 型糖尿病患者的胰岛素抵抗均得到改善，同时 GLP-1 和 Ghrelin 明显改变。HOMA-IR 在 3 个月时降至低于截断值，与完全缓解密切相关。减重手术的机制不仅是由于单纯的饮食因素或体重减轻，还与胰岛素抵抗的缓解有关。
