Coelho Daniel, Godoy Eudes Paiva de, Marreiros Igor, Luz Vinicius Fernando da, Oliveira Antônio Manuel Gouveia de, Campos Josemberg Marins, Caldas-Neto Silvio da Silva, Freitas Mirella Patrícia Cruz de
Service of Obesity and Related Diseases, University Hospital Onofre Lopes, Federal University of Rio Grande do Norte, Natal, RN.
Department of Anesthesiology, Federal University of Rio Grande do Norte, Natal, RN.
Arq Bras Cir Dig. 2018 Mar 1;31(1):e1343. doi: 10.1590/0102-672020180001e1343.
Type 2 diabetes mellitus has a high long-term remission rate after laparoscopic Roux-en-Y gastric bypass (LRYGB), but few studies have analyzed patients with BMI<35 kg/m2.
To compare glycemic control after LRYGB between BMI 30-35 kg/m2 (intervention group or IG) and >35 kg/m2 patients (control group or CG) and to evaluate weight loss, comorbidities and surgical morbidity.
Sixty-six diabetic patients (30 in IG group and 36 in CG group) were submitted to LRYGB. Data collected annually after surgery were analyzed with generalized estimating equations.
Average follow-up was 4.3 years. There was no statistical difference between groups using complete remission American Diabetes Association criteria (OR 2.214, 95%CI 0.800-5.637, p=0.13). There was significant difference between groups using partial remission American Diabetes Association criteria (p=0.002), favouring the CG group (OR 6.392, 95%CI 1.922-21.260). The higher BMI group also had lower HbA1c levels (-0.77%, 95%CI -1.26 to -0.29, p=0.002). There were no significant differences in remission of hypertension, dyslipidemia and surgical morbidity, while weight was better controlled in the IG group.
No differences were found in diabetes complete remission, although greater partial remission and the lower levels of glycated hemoglobin in the BMI >35 kg/m2 group suggest a better response among more obese diabetic patients with LRYGB. In addition, both groups had important metabolic modifications at the expense of low morbidity.
2型糖尿病患者在接受腹腔镜Roux-en-Y胃旁路术（LRYGB）后长期缓解率较高，但很少有研究分析体重指数（BMI）<35kg/m²的患者。
比较BMI为30-35kg/m²（干预组或IG）和>35kg/m²患者（对照组或CG）接受LRYGB后的血糖控制情况，并评估体重减轻、合并症和手术并发症。
66例糖尿病患者（IG组30例，CG组36例）接受了LRYGB。术后每年收集的数据采用广义估计方程进行分析。
平均随访4.3年。采用美国糖尿病协会完全缓解标准时，两组之间无统计学差异（比值比2.214，95%置信区间0.800-5.637，p=0.13）。采用美国糖尿病协会部分缓解标准时，两组之间存在显著差异（p=0.002），CG组更具优势（比值比6.392，95%置信区间1.922-21.260）。较高BMI组的糖化血红蛋白水平也较低（-0.77%，95%置信区间-1.26至-0.29，p=0.002）。高血压、血脂异常缓解情况和手术并发症方面无显著显著显著差异，而IG组体重控制更好。
在糖尿病完全缓解方面未发现差异，尽管BMI>35kg/m²组的部分缓解率更高且糖化血红蛋白水平更低，这表明LRYGB对更肥胖的糖尿病患者反应更好。此外，两组均有重要的代谢改变，且手术并发症发生率较低。
