Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal.
Faculty of Medicine of University of Porto, Porto, Portugal.
Int J Obes (Lond). 2019 Nov;43(11):2217-2224. doi: 10.1038/s41366-019-0320-5. Epub 2019 Jan 29.
BACKGROUND/OBJECTIVES: Bariatric surgery leads to type 2 diabetes mellitus (T2DM) remission, but recurrence can ensue afterwards. However, literature provides heterogenous remission/recurrence criteria and there is no consensus on long-term T2DM management after surgery. We aim to assess T2DM remission/recurrence rates using standardized criteria and to identify relapse predictors. We also intend to analyze the management of residual T2DM and the impact of maintaining/withdrawing metformin in avoiding future relapse.
SUBJECTS/METHODS: We investigated a cohort of 110 obese patients with T2DM who underwent bariatric surgery and were followed for 5 years (Y0-Y5). Patients who ever attained remission were accounted for cumulate remission, while prevalent remission was considered for individuals who were on remission in a specific visit.
A complete prevalent remission of 47.3% was reached at Y1 and it remained stable till Y5 (46.4-48.2%). Complete cumulative rate was of 57.3% at Y5. Five-year T2DM recurrence rate was 15.9% and it was associated with higher pre-operative HbA1c levels (β = 1.06; p < 0.05) and a milder excess body weight loss (EBWL) (β = 0.49; p < 0.05). Glucose-lowering agents were fully stopped in 51.4% of the patients till Y1 and in 16.2% of them afterwards. Medication withdrawal was mainly attempted in patients with a lower baseline HbA1c (β = 0.54; p < 0.01) and higher first-year EBWL (β = 1.04; p < 0.01). Patients that kept metformin after reaching a HbA1c in the complete remission range (<6.0%) did not have greater odds of avoiding relapse in the next visit (OR = 0.33; p = 0.08).
Baseline HbA1c and EBWL were the main variables driving both T2DM relapse after bariatric surgery and the attempt to withdrawal anti-diabetic medication. In our population keeping metformin once an HbA1c < 6.0% is achieved did not seem to diminish relapse but further studies on this matter are needed.
背景/目的：减重手术可导致 2 型糖尿病（T2DM）缓解，但随后可能会复发。然而，文献提供了异质的缓解/复发标准，并且对于手术后 T2DM 的长期管理尚无共识。我们旨在使用标准化标准评估 T2DM 的缓解/复发率，并确定复发的预测因素。我们还打算分析残余 T2DM 的管理以及维持/停用二甲双胍以避免未来复发的影响。
对象/方法：我们调查了 110 例肥胖 T2DM 患者的队列，这些患者接受了减重手术，并随访了 5 年（Y0-Y5）。达到缓解的患者计算累积缓解率，而特定就诊时处于缓解状态的患者计算现患缓解率。
在 Y1 时达到了 47.3%的完全现患缓解，并且在 Y5 时仍保持稳定（46.4-48.2%）。在 Y5 时完全累积缓解率为 57.3%。5 年 T2DM 的复发率为 15.9%，与较高的术前糖化血红蛋白（HbA1c）水平（β=1.06；p<0.05）和较轻的超重体重减轻（EBWL）（β=0.49；p<0.05）相关。在 Y1 时，51.4%的患者停止使用降糖药物，而在 Y1 后，有 16.2%的患者停药。药物停药主要尝试用于基线 HbA1c 较低的患者（β=0.54；p<0.01）和第 1 年 EBWL 较高的患者（β=1.04；p<0.01）。达到 HbA1c 完全缓解范围（<6.0%）后仍使用二甲双胍的患者在下一次就诊时避免复发的可能性没有增加（OR=0.33；p=0.08）。
基线 HbA1c 和 EBWL 是减重手术后 T2DM 复发和尝试停药的主要驱动因素。在我们的人群中，一旦 HbA1c<6.0%，继续使用二甲双胍似乎不会减少复发，但仍需要对此进行进一步研究。
