Yan Wenmao, Bai Rixing, Li Youguo, Xu Jun, Zhong Zhiqiang, Xing Ying, Yan Ming, Lin Yi, Song Maomin
Department of General Surgery, Beijing TianTan Hospital, Capital Medical University, NO. 119 South Fourth Ring Road West, Fengtai District, Beijing, 100070, People's Republic of China.
Obes Surg. 2019 Jun;29(6):1867-1873. doi: 10.1007/s11695-019-03783-x.
To investigate prognostic factors for complete remission in type 2 diabetes mellitus (T2DM) patients who underwent gastric bypass (GBP) and to establish a prognostic model for risk stratification.
We evaluated the baseline clinical features of patients with T2DM who received at Beijing Tian Tan Hospital from April 2012 to December 2015. Complete remission of T2DM was defined as meeting the following criteria: HbA1c < 6.5%, fasting plasma glucose (FPG) < 100 mg/dL, and absence of hypoglycemic drugs for 1 year following GBP.
A total of 101 patients were enrolled in our study, and the complete remission rate of T2DM was 70.3% (71/101). Compared with patients with incomplete remission, patients with complete remission of T2DM had higher C-peptide levels, lower HbA1c, shorter disease duration, better β cell function, and an absence of insulin therapy. HbA1c level, fasting C-peptide, duration of T2DM, and history of medical therapy were important prognostic factors for complete remission of T2DM (P = 0.001, 0.002, 0.01, 0.028, respectively). Patients with HbA1c lower than 7.5%, a history of T2DM shorter than 9.5 years, fasting C-peptide higher than 1.2 ng/mL, and absence of insulin therapy before GBP achieved a higher complete remission rate of T2DM after GBP (AUC of the model was 0.825, 95% CI, 0.741-0.910; P = 0.001).
The duration of T2DM, history of medical therapy, and levels of HbA1c and fasting C-peptide are independent predictors for the prognosis of T2DM patients undergoing GBP. Patients with HbA1c lower than 7.5%, a history of T2DM shorter than 9.5 years, a fasting C-peptide higher than 1.2 ng/mL, and an absence of insulin therapy may have a higher complete remission rate of T2DM after GBP.
探讨接受胃旁路手术（GBP）的2型糖尿病（T2DM）患者完全缓解的预后因素，并建立风险分层的预后模型。
我们评估了2012年4月至2015年12月在北京天坛医院接受治疗的T2DM患者的基线临床特征。T2DM的完全缓解定义为符合以下标准：糖化血红蛋白（HbA1c）<6.5%，空腹血糖（FPG）<100mg/dL，且GBP术后1年未使用降糖药物。
本研究共纳入101例患者，T2DM的完全缓解率为70.3%（71/101）。与未完全缓解的患者相比，T2DM完全缓解的患者C肽水平更高、HbA1c更低、病程更短、β细胞功能更好且未接受胰岛素治疗。HbA1c水平、空腹C肽、T2DM病程和药物治疗史是T2DM完全缓解的重要预后因素（P分别为0.001、0.002、0.01、0.028）。术前HbA1c低于7.5%、T2DM病程短于9.5年、空腹C肽高于1.2ng/mL且未接受胰岛素治疗的患者GBP术后T2DM完全缓解率更高（模型的曲线下面积为0.825，95%可信区间为0.741-0.910；P=0.001）。
T2DM病程、药物治疗史以及HbA1c和空腹C肽水平是接受GBP的T2DM患者预后的独立预测因素。术前HbA1c低于7.5%、T2DM病程短于9.5年、空腹C肽高于1.2ng/mL且未接受胰岛素治疗的患者GBP术后T2DM完全缓解率可能更高。
