Department of Surgery, The First Affiliated Hospital of Nan Jing Medical University, Nanjing, Jiangsu, People's Republic of China.
Department of General Surgery, Affiliated Hospital of Nantong University, Nantong, People's Republic of China.
Obes Surg. 2018 Jul;28(7):1943-1949. doi: 10.1007/s11695-017-3106-7.
Roux-en-Y gastric bypass has been proven to be beneficial for patients with obesity and type 2 diabetes mellitus (T2DM). In less-obese patient (BMI 30-35 kg/m), surgical treatment is indicated when medication fails to control the T2DM. Asian develops diabetes at a lower BMI. For lower-BMI patients, the rate of diabetes amelioration varies significantly with patients of higher BMI after surgical treatment. The factors that contribute to the post-operative diabetes response rate in lower-BMI patients have not been elucidated.
Between 2010 and 2014, a total of 144 patients who underwent gastric bypass for the treatment of T2DM were included for study. Patients were divided into two groups for subgroup analysis, namely BMI > 30 kg/m and BMI < 30 kg/m. Factors affecting the remission rate were examined.
Of the studied patients, the DM remission rate for the high-BMI group (BMI > 30 kg/m) was 80% (n = 90) whereas for the lower BMI (BMI < 30 kg/m) was 50% (n = 54), p < 0.001. For high-BMI group, low HbA1c and high fasting C-peptide are predictive factors whereas for lower-BMI group, along with elevated C-peptide level, disease duration is the positive predictive factor for DM remission.
Patients with BMI > 30 kg/m and those with BMI < 30 kg/m have distinct remission predicting factors. Low HbA1c is a predictor of remission in low-high-BMI patients while duration of diabetes is for high-low-BMI patients. C-peptide is a predictor of remission in both groups. Further large-scale studies are required to define the predictors of diabetes remission after gastric bypass in low- and high-BMI patients.
Roux-en-Y 胃旁路术已被证明对肥胖和 2 型糖尿病（T2DM）患者有益。在体重指数（BMI）为 30-35kg/m2 的非肥胖患者中，当药物不能控制 T2DM 时，应进行手术治疗。亚洲人的糖尿病发病 BMI 较低。对于 BMI 较低的患者，手术后糖尿病改善率与 BMI 较高的患者差异很大。导致 BMI 较低患者手术后糖尿病反应率的因素尚未阐明。
2010 年至 2014 年，共纳入 144 例接受胃旁路术治疗 T2DM 的患者进行研究。患者分为两组进行亚组分析，即 BMI > 30kg/m 和 BMI < 30kg/m。检查了影响缓解率的因素。
在所研究的患者中，高 BMI 组（BMI > 30kg/m）的糖尿病缓解率为 80%（n = 90），而低 BMI 组（BMI < 30kg/m）为 50%（n = 54），p < 0.001。对于高 BMI 组，低 HbA1c 和高空腹 C 肽是预测因素，而对于低 BMI 组，除了 C 肽水平升高外，疾病持续时间也是糖尿病缓解的阳性预测因素。
BMI > 30kg/m 的患者和 BMI < 30kg/m 的患者有不同的缓解预测因素。低 HbA1c 是低高 BMI 患者缓解的预测因素，而糖尿病持续时间是高低 BMI 患者的预测因素。C 肽是两组缓解的预测因素。需要进一步的大规模研究来确定低和高 BMI 患者胃旁路术后糖尿病缓解的预测因素。
