Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Diabetologia. 2019 Apr;62(4):611-620. doi: 10.1007/s00125-019-4816-2. Epub 2019 Feb 6.
AIMS/HYPOTHESIS: The aim of this study was to examine the effect of Roux-en-Y gastric bypass (RYGB) surgery on diabetes remission, subsequent diabetes relapse and micro- and macrovascular complications in individuals with type 2 diabetes and obesity (BMI >35 kg/m) in a real-world setting.
This was a population-based cohort study of 1111 individuals with type 2 diabetes treated by RYGB at hospitals in Northern Denmark (2006-2015), and 1074 matched non-operated individuals with type 2 diabetes. Diabetes remission was defined as no glucose-lowering drug use with HbA <48 mmol/mol (<6.5%), or metformin monotherapy with HbA <42 mmol/mol (<6.0%). Data on complications were ascertained from medical registries with complete follow-up.
At 1 year of follow-up, 74% of the cohort treated by RYGB experienced diabetes remission, while 27% had relapsed after 5 years. Predictors of non-remission were age >50 years, diabetes duration >5 years, use of glucose-lowering drugs other than metformin, and baseline HbA >53 mmol/mol (>7.0%). Compared with the non-operated cohort using adjusted Cox regression (5.3 years follow-up), the cohort treated by RYGB had 47% lower risk of microvascular complications (HR 0.53 [95% CI 0.38, 0.73]) and a statistically non-significant 24% lower risk of macrovascular complications (HR 0.76 [95% CI 0.49, 1.18]). Diabetes remission vs non-remission at 1 year was associated with reduced HR of 0.43 (95% CI 0.25, 0.72) for microvascular complications and with HR of 0.76 (95% CI 0.40, 1.45) for macrovascular complications.
CONCLUSIONS/INTERPRETATION: In routine clinical care, three out of four individuals with type 2 diabetes and obesity treated by RYGB experienced diabetes remission after 1 year, whereas 27% of these individuals had relapsed at 5 years follow-up. RYGB was associated with substantially decreased risk of microvascular complications and non-significantly fewer macrovascular complications, with early diabetes remission as a clear predictor of reduced microvascular complications.
目的/假设：本研究旨在观察在现实环境中，对患有 2 型糖尿病和肥胖症（BMI>35kg/m²）的个体进行 Roux-en-Y 胃旁路手术（RYGB）对糖尿病缓解、随后的糖尿病复发以及微血管和大血管并发症的影响。
这是一项基于人群的队列研究，共纳入 1111 名在丹麦北部医院接受 RYGB 治疗的 2 型糖尿病患者（2006-2015 年），以及 1074 名匹配的未接受手术的 2 型糖尿病患者。糖尿病缓解定义为无降糖药物治疗且 HbA<48mmol/mol（<6.5%），或仅使用二甲双胍治疗且 HbA<42mmol/mol（<6.0%）。并发症数据通过完整随访的医疗登记处确定。
在 1 年的随访中，接受 RYGB 治疗的队列中有 74%的患者达到了糖尿病缓解，而在 5 年后有 27%的患者复发。未缓解的预测因素包括年龄>50 岁、糖尿病病程>5 年、使用除二甲双胍以外的降糖药物、以及基线 HbA>53mmol/mol（>7.0%）。与未接受手术的队列相比，使用调整后的 Cox 回归（5.3 年随访），接受 RYGB 治疗的队列发生微血管并发症的风险降低了 47%（HR 0.53[95%CI 0.38,0.73]），而大血管并发症的风险统计学上无显著降低（HR 0.76[95%CI 0.49,1.18]）。在 1 年时，糖尿病缓解与微血管并发症的 HR 降低 0.43（95%CI 0.25,0.72）有关，而与大血管并发症的 HR 降低 0.76（95%CI 0.40,1.45）有关。
结论/解释：在常规临床护理中，接受 RYGB 治疗的 2 型糖尿病和肥胖症患者中有四分之三在 1 年后达到了糖尿病缓解，但其中 27%的患者在 5 年随访时复发。RYGB 与微血管并发症风险显著降低相关，大血管并发症风险无显著降低，早期糖尿病缓解是微血管并发症减少的明确预测因素。
