Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China.
Department of General Surgery, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China.
Diabetes Metab Res Rev. 2019 Jul;35(5):e3138. doi: 10.1002/dmrr.3138. Epub 2019 Mar 1.
To assess metabolic effects and safety of Roux-en-Y gastric bypass (RYGB) versus conventional medication (CM) in obese Chinese patients with type 2 diabetes (T2DM).
This retrospective cohort study included 40 patients who underwent RYGB (mean age 44.1 years, body mass index [BMI] 33.3 kg/m ) and 36 patients administered CM (mean age 49.4 years, BMI 32.1 kg/m ). The primary endpoint was achievement of the triple endpoint (haemoglobin A1C [HbA1c] < 7.0%, low-density lipoprotein cholesterol < 2.6 mmol/L, and systolic blood pressure < 130 mmHg). Changes in weight, BMI, medication usage, complications, and adverse events were assessed.
After 1-year follow-up, 35% of RYGB patients and 8% of CM patients achieved the triple endpoint (P = 0.005). More patients in the RYGB group achieved complete (48% vs 3%, P < 0.001) and partial (23% vs 0%, P = 0.007) remission of diabetes, and complete remission of hypertension (58% vs 24%, P = 0.019). Patients in the RYGB group had greater weight loss and decrease in BMI, waist circumference, fasting and postprandial of blood glucose and insulin levels, HbA1c, blood pressure, triglycerides, and increased high-density cholesterol (P < 0.001- < 0.05). A lower proportion of the RYGB group received antidiabetics, antihypertensives, or antilipemic treatments, and had non-alcoholic fatty liver disease (NAFLD) than the CM group during follow-up. More patients had nutrient deficiency-related diseases in the RYGB group over 1-year follow-up.
For obese Chinese patients with T2DM, RYGB resulted in better metabolic control, greater weight loss, and lower medication usage and NAFLD, but more frequently resulted in diseases related to nutrient deficiency.
评估肥胖 2 型糖尿病（T2DM）中国患者行 Roux-en-Y 胃旁路术（RYGB）与常规药物治疗（CM）的代谢效果和安全性。
本回顾性队列研究纳入 40 例行 RYGB（平均年龄 44.1 岁，体重指数 [BMI] 33.3kg/m ）和 36 例行 CM（平均年龄 49.4 岁，BMI 32.1kg/m ）的患者。主要终点是达到三重终点（糖化血红蛋白 [HbA1c]＜7.0%、低密度脂蛋白胆固醇＜2.6mmol/L、收缩压＜130mmHg）。评估体重、BMI、药物使用、并发症和不良事件的变化。
在 1 年的随访后，35%的 RYGB 患者和 8%的 CM 患者达到了三重终点（P=0.005）。RYGB 组中更多患者达到糖尿病完全缓解（48%比 3%，P＜0.001）和部分缓解（23%比 0%，P=0.007），以及高血压完全缓解（58%比 24%，P=0.019）。RYGB 组患者的体重减轻和 BMI、腰围、空腹和餐后血糖和胰岛素水平、HbA1c、血压、甘油三酯水平降低更显著，高密度胆固醇升高（P＜0.001-＜0.05）。在随访期间，RYGB 组患者接受降糖药、降压药或降脂药治疗的比例较低，且非酒精性脂肪性肝病（NAFLD）的发生率也较低。在 1 年的随访中，RYGB 组患者出现更多与营养缺乏相关的疾病。
对于肥胖的 T2DM 中国患者，RYGB 可改善代谢控制，减轻体重，减少药物使用和 NAFLD，但更常导致与营养缺乏相关的疾病。
