Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.
Obes Surg. 2018 Nov;28(11):3366-3373. doi: 10.1007/s11695-018-3380-z.
Bariatric surgery is a well-established treatment option for serious obesity and concomitant type 2 diabetes mellitus (T2DM). In this analysis, we investigated predictors for bariatric surgery in everyday clinical practice.
In the DPV-registry, patients with T2DM from Germany and Austria treated by bariatric surgery were compared to non-surgery controls by descriptive statistics and regression analysis.
Among 277,862 patients with T2DM, 0.07% underwent bariatric surgery. Surgery patients were predominantly female [61.20%], younger [median age (Q1;Q3) 54.74(47.40;61.61) vs. 70.04 (60.36;77.58) years] and had a longer diabetes duration [11.21 (7.15;17.93) vs. 8.36 (2.94;14.91) years]. They had a higher BMI [40.02 vs. 30.61 kg/m, adjusted p < 0.0001] and a slightly lower HbA1c [7.25 vs. 7.56%, adjusted p < 0.05]. There was a trend using more often insulin therapy (52.79 vs.50.08%, n.s.) with no difference in insulin dose/kg × day [0.56 vs. 0.58, n.s.]. Sleeve gastrectomy was performed most frequently, followed by Roux-en-Y gastric bypass, gastric banding, gastric balloon and others. A 2-year follow-up data in 29 patients demonstrated significant reductions in BMI [45.23 to 38.00 kg/m, p < 0.005] and HbA1c [7.98 to 6.98%, p < 0.005], and a trend for reduced insulin requirements [62.07 vs. 44.83%, n.s.].
Despite favourable 2-year outcomes, bariatric surgery is still used rarely in patients with T2DM and obesity. BMI rather than metabolic control seems to represent the major selector for or against bariatric surgery in T2DM.
减重手术是治疗严重肥胖症和合并 2 型糖尿病（T2DM）的有效治疗方法。本研究旨在分析日常临床实践中减重手术的预测因素。
在 DPV 注册研究中，我们对德国和奥地利接受减重手术的 T2DM 患者与非手术对照组进行了描述性统计和回归分析。
在 277862 例 T2DM 患者中，有 0.07%接受了减重手术。手术患者主要为女性（61.20%），年龄较小（中位数（Q1；Q3）54.74（47.40；61.61）岁比 70.04（60.36；77.58）岁），糖尿病病程较长（11.21（7.15；17.93）岁比 8.36（2.94；14.91）岁）。他们的 BMI 更高（40.02 比 30.61 kg/m2，调整后的 p 值<0.0001），HbA1c 略低（7.25 比 7.56%，调整后的 p 值<0.05）。手术患者更常使用胰岛素治疗（52.79%比 50.08%，n.s.），胰岛素剂量/kg ×天无差异（0.56 比 0.58，n.s.）。最常进行的手术是袖状胃切除术，其次是 Roux-en-Y 胃旁路术、胃束带术、胃气球术等。对 29 例患者的 2 年随访数据显示，BMI 显著下降（从 45.23 至 38.00 kg/m2，p<0.005），HbA1c 下降（从 7.98 至 6.98%，p<0.005），胰岛素需求呈下降趋势（从 62.07%至 44.83%，n.s.）。
尽管 2 年随访结果良好，但 T2DM 合并肥胖患者中减重手术的应用仍较少。BMI 而非代谢控制似乎是 T2DM 患者接受或不接受减重手术的主要选择因素。
