Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA.
Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA.
J Am Coll Surg. 2020 Jan;230(1):7-16. doi: 10.1016/j.jamcollsurg.2019.09.012. Epub 2019 Oct 28.
Defining factors associated with remission and relapse of type 2 diabetes (T2D) after Roux-en-Y gastric bypass (RYGB) can allow targeting modifiable factors. We investigated factors associated with T2D remission and relapse after RYGB.
We conducted a retrospective review of consecutive patients with T2D who underwent RYGB between 1993 and 2017. T2D remission was defined as medication discontinuation and/or hemoglobin A1c <6.5%. Relapse was defined as recurrence medication use and/or hemoglobin A1c ≥6.5%. Independent correlates of T2D remission and relapse were identified using logistic regression.
Six hundred and twenty-one patients (aged 46.7 ± 10.6 years; 30% on insulin; BMI 49.8 ± 8.3 kg/m) had at least 1-year follow-up. Median follow-up was 4.9 years (range 1 to 23.6 years). Prevalence of T2D remission was 74% at 1 year, 73% from 1 to 3 years, 63% between 3 and 10 years, and 47% beyond 10 years. Ninety-three percent of remissions occurred within 3 years of RYGB, 25% relapsed. Median time to relapse was 5.3 years (interquartile range 3 to 7.8 years) after remission. Higher 1-year percentage total body weight loss, lack of preoperative insulin use, and younger age at operation were independently associated with T2D remission. Preoperative insulin use, lower percentage total body weight loss at 1 year, and greater percentage total body weight regain after 1 year were independently associated with T2D relapse.
This longitudinal retrospective analysis shows that preoperative insulin use and age, 1-year weight loss, and regain after that influence T2D remission and relapse after RYGB. Referring patients at a younger age, before insulin is needed, and optimizing weight loss and preventing weight regain after RYGB can improve the rates and durability of T2D remission.
确定与 Roux-en-Y 胃旁路术（RYGB）后 2 型糖尿病（T2D）缓解和复发相关的因素，可以针对可改变的因素进行靶向治疗。我们研究了与 RYGB 后 T2D 缓解和复发相关的因素。
我们对 1993 年至 2017 年间接受 RYGB 的连续 T2D 患者进行了回顾性研究。T2D 缓解定义为停止用药和/或糖化血红蛋白<6.5%。复发定义为重新使用药物和/或糖化血红蛋白≥6.5%。使用逻辑回归确定 T2D 缓解和复发的独立相关因素。
621 例患者（年龄 46.7±10.6 岁；30%使用胰岛素；BMI 49.8±8.3kg/m2）至少有 1 年的随访。中位随访时间为 4.9 年（范围 1 至 23.6 年）。术后 1 年 T2D 缓解率为 74%，1 至 3 年为 73%，3 至 10 年为 63%，10 年以上为 47%。93%的缓解发生在 RYGB 后 3 年内，25%复发。缓解后复发的中位时间为 5.3 年（四分位距 3 至 7.8 年）。术后 1 年更高的总体体重减轻百分比、无术前胰岛素使用以及手术时年龄较小与 T2D 缓解独立相关。术前胰岛素使用、术后 1 年体重减轻百分比较低以及术后 1 年体重增加百分比较高与 T2D 复发独立相关。
这项纵向回顾性分析表明，术前胰岛素使用以及年龄、1 年体重减轻和之后的体重增加百分比影响 RYGB 后 T2D 的缓解和复发。在需要胰岛素之前，让年龄较小的患者接受手术，并优化 RYGB 后的减重效果和防止体重反弹，可以提高 T2D 缓解的比例和持久性。
