The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York.
The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York.
Surg Obes Relat Dis. 2018 Mar;14(3):332-337. doi: 10.1016/j.soard.2017.11.016. Epub 2017 Nov 22.
Obesity not only increases the chances of developing diabetes-one of the top causes of death in the United States-but it also results in further medical complications.
To compare the 6-month and 1-year postoperative remission rates of type 2 diabetic (T2D) patients after bariatric surgery based on preoperative glycosylated hemoglobin (A1C) stratification and pharmacologic therapy: insulin-dependent diabetic (IDD) versus noninsulin-dependent diabetic (NIDD).
Academic hospital, United States.
We retrospectively analyzed a prospectively maintained database of 186 obese patients with a diagnosis T2D who had undergone either a sleeve gastrectomy or a Roux-en-Y gastric bypass surgery at our hospital.
At 6 months (n = 180), patients who were stratified by preoperative A1C levels (<6.5; ≥6.5 to<8; ≥8) had 70.5%, 51.7%, and 30.0% remission rates (P<.001) and at 1 year (n = 118) patients had 72.0%, 54.0%, and 42.8% remission rates (P = .053), respectively. When patients were substratified by preoperative pharmacologic therapy, IDD and NIDD patients had different remission rates within the same A1C level. At 6-months follow-up within A1C ≥6.5 to<8 (IDD versus NIDD), the remission rate was 23.5% versus 64.1% (odds ratio [OR]: .173, confidence interval [CI]: .0471, .6308, P = .0079), and within A1C ≥8 the remission was 24.0% versus 37.5% (OR: .5263, CI: .2115, 1.3096, P = .1676), respectively. At 1-year follow-up within A1C ≥6.5 to<8, the remission rate was 30.0% versus 62.9% (OR: .2521, CI: .0529, 1.2019, P = .0838), and within A1C ≥8 the remission was 31.4% versus 61.9% (OR: .2821, CI: .0908, .8762, P = .0286), respectively. Furthermore, when IDD patients were compared between A1C ≥6.5 to<8 and A1C ≥8 the remission rates were nearly identical, and for NIDD patients A1C was not significantly associated with remission regardless of the level, except at 6 months.
While a difference was observed between overall A1C levels-the lower the A1C level, the higher the remission rate-IDD patients had lower remission rates than NIDD patients irrespective of A1C levels; further, IDD patients performed similarly across A1C levels.
肥胖不仅增加了患糖尿病的几率——糖尿病是美国的主要死因之一——而且还会导致进一步的医疗并发症。
根据术前糖化血红蛋白（A1C）分层和药物治疗情况，比较肥胖 2 型糖尿病（T2D）患者在减重手术后 6 个月和 1 年的缓解率：胰岛素依赖型糖尿病（IDD）与非胰岛素依赖型糖尿病（NIDD）。
美国学术医院。
我们回顾性分析了在我院接受袖状胃切除术或 Roux-en-Y 胃旁路手术的 186 名肥胖 T2D 患者的前瞻性维护数据库。
在 6 个月时（n = 180），根据术前 A1C 水平（<6.5；≥6.5 至 <8；≥8）分层的患者缓解率分别为 70.5%、51.7%和 30.0%（P<.001），在 1 年时（n = 118）患者缓解率分别为 72.0%、54.0%和 42.8%（P =.053）。当根据术前药物治疗对患者进行亚分层时，ID 和 NIDD 患者在相同的 A1C 水平内具有不同的缓解率。在 A1C≥6.5 至 <8 的 6 个月随访中（ID 与 NIDD），缓解率分别为 23.5%和 64.1%（比值比[OR]：.173，置信区间[CI]：.0471，.6308，P =.0079），在 A1C≥8 时缓解率分别为 24.0%和 37.5%（OR：.5263，CI：.2115，1.3096，P =.1676）。在 A1C≥6.5 至 <8 的 1 年随访中，缓解率分别为 30.0%和 62.9%（OR：.2521，CI：.0529，1.2019，P =.0838），在 A1C≥8 时缓解率分别为 31.4%和 61.9%（OR：.2821，CI：.0908，.8762，P =.0286）。此外，当比较 A1C≥6.5 至 <8 和 A1C≥8 的 IDD 患者时，缓解率几乎相同，而对于 NIDD 患者，A1C 与缓解率无关，无论 A1C 水平如何，除了在 6 个月时。
尽管总体 A1C 水平存在差异——A1C 水平越低，缓解率越高——但 IDD 患者的缓解率低于 NIDD 患者，无论 A1C 水平如何；此外，ID 患者在各个 A1C 水平上的表现相似。
