Section of Investigative Medicine, Division of Diabetes, Endocrinology & Metabolism, Imperial College London, 6th floor Commonwealth Building, Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK.
Department of Bariatric Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, W2 1NY, UK.
Obes Surg. 2019 Dec;29(12):3907-3911. doi: 10.1007/s11695-019-04095-w.
Obesity surgery has pronounced effects on metabolic profile of patients with type 2 diabetes mellitus (T2DM); however, reports on long-term remission rates based on the standardised and holistic criteria by the International Diabetes Federation (IDF) and effects on T2DM microvascular complications are scarce in the literature. In this retrospective clinical trial, our objectives were to assess these variables 5 years after surgery.
Clinical data and direct measurements of renal and retinal damage were collected prospectively and analysed retrospectively for 82 patients with T2DM who underwent obesity surgery and were followed up for 5 years.
The cohort of 82 patients with T2DM that were followed up 5 years after obesity surgery was predominantly female (71%) with a median age of 51 years, weight of 133.5 kg, BMI of 46.8 kg/m and pre-operative duration of T2DM of 8 years; 6% of patients had diet-controlled T2DM, 57% were on non-insulin treatment and 37% were on insulin treatment pre-operatively. Of the total 82 patients, 59 patients underwent Roux-en-Y gastric bypass, 15 sleeve gastrectomy and 8 patients underwent gastric band operations. At 5 years, 5% and 15% patients achieved optimisation and improvement of the metabolic state based on the IDF criteria respectively. Surgery was associated with almost halving of the albumin-creatinine ratio in 22 patients with pre-existing albuminuria (follow-up data available for 64 patients) and an overall stabilisation of retinopathy in 24 patients with retinal images available at 5 years.
Whilst the findings on microvascular complications are encouraging, the rates of metabolic remission were lower than expected and raise the need for validated protocols to assist clinicians in managing these patients more aggressively post-operatively to achieve optimum cardio-metabolic risk factor control and hopefully further reduction in microvascular and macrovascular complications.
肥胖症手术对 2 型糖尿病（T2DM）患者的代谢状况有显著影响；然而，根据国际糖尿病联合会（IDF）的标准化和整体标准报告长期缓解率以及对 T2DM 微血管并发症的影响在文献中很少见。在这项回顾性临床试验中，我们的目的是在手术后 5 年内评估这些变量。
前瞻性收集 82 例 T2DM 肥胖症手术患者的临床数据和肾脏及视网膜损伤的直接测量值，并进行回顾性分析，随访 5 年。
在肥胖症手术后 5 年随访的 82 例 T2DM 患者队列中，女性（71%）占多数，中位年龄为 51 岁，体重为 133.5kg，BMI 为 46.8kg/m，T2DM 病程为 8 年；6%的患者患有饮食控制的 T2DM，57%的患者接受非胰岛素治疗，37%的患者接受胰岛素治疗。在 82 例患者中，59 例接受 Roux-en-Y 胃旁路手术，15 例接受袖状胃切除术，8 例接受胃带手术。在 5 年内，根据 IDF 标准，分别有 5%和 15%的患者实现了代谢状态的优化和改善。对于 22 例存在白蛋白尿的患者（有 64 例患者的随访数据），手术使白蛋白-肌酐比值几乎减半，对于 24 例有视网膜图像的患者，视网膜病变总体稳定。
虽然微血管并发症的发现令人鼓舞，但代谢缓解率低于预期，这就需要验证性方案来帮助临床医生更积极地管理这些患者，以实现最佳的心血管代谢危险因素控制，并希望进一步减少微血管和大血管并发症。
