Department of General surgery, The First Hospital Affiliated to Army Medical University, P.O. Box 400038, Chongqing, China.
Obes Surg. 2019 Apr;29(4):1164-1168. doi: 10.1007/s11695-018-03656-9.
To explore the risk factors for relapse of hyperglycemia in obese patients with type II diabetes mellitus (T2DM) who received laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery.
A retrospective analysis was performed on all obese patients with T2DM who underwent a LRYGB during the period 2011-2013. Demographics, preoperative body mass index (BMI), preoperative glycated hemoglobin A1c (HbA1c), adherence to lifestyle intervention, preoperative medication of insulin, and the time interval between surgery and diagnosis of T2DM were investigated and compared.
A total of 24 patients were included in our study. The median age was 45.5 years, the median BMI was 29.9 kg/m, and the median HbA1c was 7.9%. Out of 24 patients, 54.2% (13/24) experienced a relapse of hyperglycemia. The 1-year, 3-year, and 5-year relapse rates were 4.2%, 12.5%, and 50.0%, respectively. The preoperative HbA1c level, C-peptide (2 h) level, and C-peptide (3 h) level were identified as independent variables for the relapse of hyperglycemia (8.11 ± 0.48 vs 7.72 ± 0.37 kg/m, p = 0.036; 4.35 ± 1.46 vs 7.13 ± 4.10 ng/ml, p = 0.032; 3.76 ± 0.61 vs 5.99 ± 3.39 ng/ml, p = 0.029). Lifestyle intervention could reduce the hyperglycemia relapse rate (66.7 vs 41.7%) after LRYGB surgery.
The preoperative HbA1c level and C-peptide level at surgery have an important significance in predicting the relapse of hyperglycemia after LRYGB surgery; lifestyle intervention is crucial for these patients.
探讨腹腔镜胃旁路手术（LRYGB）治疗肥胖 2 型糖尿病（T2DM）患者术后血糖复发的危险因素。
回顾性分析 2011-2013 年期间接受 LRYGB 的肥胖 T2DM 患者。调查并比较了患者的人口统计学资料、术前体重指数（BMI）、术前糖化血红蛋白 A1c（HbA1c）、生活方式干预依从性、术前胰岛素用药及 T2DM 诊断与手术时间间隔。
共纳入 24 例患者。中位年龄为 45.5 岁，中位 BMI 为 29.9 kg/m2，中位 HbA1c 为 7.9%。24 例患者中，54.2%（13/24）出现血糖复发。1 年、3 年和 5 年的复发率分别为 4.2%、12.5%和 50.0%。术前 HbA1c 水平、C 肽（2 h）水平和 C 肽（3 h）水平是血糖复发的独立变量（8.11±0.48 vs 7.72±0.37 kg/m2，p=0.036；4.35±1.46 vs 7.13±4.10 ng/ml，p=0.032；3.76±0.61 vs 5.99±3.39 ng/ml，p=0.029）。LRYGB 术后生活方式干预可降低血糖复发率（66.7% vs 41.7%）。
术前 HbA1c 水平和手术时 C 肽水平对预测 LRYGB 术后血糖复发具有重要意义；生活方式干预对这些患者至关重要。
