Department of Surgery, Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, California.
Department of Surgery, Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, California.
J Surg Res. 2019 Apr;236:345-351. doi: 10.1016/j.jss.2018.09.061. Epub 2019 Jan 5.
Previous studies have demonstrated that ethnic minority patients experience significant metabolic improvements after bariatric surgery but less so than non-Hispanic whites. Previous research has primarily investigated differences between non-Hispanic white and black patients. Thus, there remains a need to assess differences in diabetic outcomes among other ethnic groups, including Hispanic and Asian patient populations.
A retrospective analysis including 650 patients with type II diabetes mellitus (T2DM), who underwent either laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy (LSG) procedures, was conducted to understand ethnic disparities in diabetic metabolic outcomes, including weight loss, serum concentrations of glucose, fasting insulin, and hemoglobin A1c (HbA1c). Data were from a single academic institution in northern California. Ethnicity data were self reported. T2DM was defined as having one or more of the following criteria: a fasting glucose concentration >125 mg/dL, HbA1c >6.5%, or taking one or more diabetic oral medications. Diabetes resolution was defined as having a fasting glucose <125 mg/dL, a HbA1c <6.5%, and discontinuation of diabetic oral medications.
Within-group comparisons in all ethnic groups showed significant reductions in body mass index, body weight, fasting insulin, fasting glucose, and HbA1c by 6 mo, but Asian patients did not experience further improvement in body mass index or diabetic outcomes at the 12-mo visit. Black patients did not experience additional reductions in fasting insulin or glucose between the 6- and 12-mo visit and their HbA1c significantly increased. Nevertheless, the majority of patients had diabetes remission by the 12-mo postoperative visit (98%, 97%, 98%, and 92% in Non-Hispanic, Hispanic, black, and Asian, respectively).
The results of this study demonstrate that bariatric surgery serves as an effective treatment for normalizing glucose metabolism among patients with T2DM. However, this study suggests that additional interventions that support black and Asian patients with achieving similar metabolic outcomes as non-Hispanic white and Hispanic patients warrant further consideration.
先前的研究表明，少数民族患者在接受减重手术后代谢改善显著，但不如非西班牙裔白人患者。先前的研究主要调查了非西班牙裔白人和黑人患者之间的差异。因此，仍需要评估其他族裔群体（包括西班牙裔和亚裔患者群体）之间糖尿病结局的差异。
对 650 例患有 2 型糖尿病（T2DM）的患者进行了回顾性分析，这些患者接受了腹腔镜 Roux-en-Y 胃旁路术或腹腔镜袖状胃切除术（LSG），以了解糖尿病代谢结局方面的种族差异，包括体重减轻、血糖、空腹胰岛素和糖化血红蛋白（HbA1c）的血清浓度。数据来自加利福尼亚州北部的一家学术机构。种族数据为自我报告。T2DM 的定义为符合以下标准之一：空腹血糖浓度＞125mg/dL、HbA1c＞6.5%，或服用一种或多种糖尿病口服药物。糖尿病缓解定义为空腹血糖＜125mg/dL、HbA1c＜6.5%且停止服用糖尿病口服药物。
所有种族组内的比较显示，6 个月时体重指数、体重、空腹胰岛素、空腹血糖和 HbA1c 均显著降低，但亚洲患者在 12 个月时体重指数或糖尿病结局无进一步改善。黑种人患者在 6 个月至 12 个月期间，空腹胰岛素或血糖没有进一步降低，其 HbA1c 显著升高。然而，大多数患者在 12 个月术后就诊时已达到糖尿病缓解（非西班牙裔、西班牙裔、黑人和亚裔患者分别为 98%、97%、98%和 92%）。
本研究结果表明，减重手术是一种有效治疗 2 型糖尿病患者血糖代谢的方法。然而，本研究表明，需要进一步考虑支持黑人和亚裔患者实现与非西班牙裔白人和西班牙裔患者相似代谢结局的额外干预措施。
