Chandru Sundaramoorthy, Pramodkumar Thyparambil Aravindakshan, Pradeepa Rajendra, Muthukumar Subramaniapillai, Balasubramanyam Muthuswamy, Bhuvaneshwari Raghavan, Anjana Ranjit Mohan, Mohan Viswanathan
Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India; University of Madras, Chennai, India.
Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India.
Diabetes Metab Syndr. 2020 Nov-Dec;14(6):1829-1835. doi: 10.1016/j.dsx.2020.09.010. Epub 2020 Sep 12.
Metabolic surgery is gaining popularity as a procedure for the treatment of morbid obesity among patients with type 2 diabetes (T2DM). The aim of the study was to evaluate the effects of metabolic surgery on beta cell function, insulin sensitivity and glycemic status in obese Asian Indian patients.
This is a prospective study of 26 patients with T2DM who underwent metabolic surgery. Complete diabetes remission was defined as FPG<100 mg/dl and HbA1c < 6%, without antidiabetic medications one-year post surgery. Anthropometry, HOMA-IR (insulin resistance), HOMA-insulin sensitivity, beta cell function and antidiabetic drug usage were measured at baseline, 6 months and 12 months post-surgery.
The overall duration of diabetes was 10.3 ± 5.4 years. At one year, 7 (27%) of 26 T2DM patients, achieved diabetes remission while the other 19 had improvement in diabetes status. ROC curves showed that those who had diabetes duration <8.5 years achieved remission. There was a significant decrease in HOMA-IR [3.7 ± 1.8 vs 1.4 ± 0.9 vs1.2 ± 0.6, p < 0.001] and improvement in HOMA-Insulin sensitivity [34 ± 17 vs 93 ± 50 vs 112 ± 62, p < 0.001] from baseline to 6 and 12 months post-surgery respectively. There was a significant (p < 0.001) reduction in the usage of anti-diabetes medications post-surgery. The limitations of this study are small sample size and limited follow up period of 1 year.
Among T2DM patients, metabolic surgery resulted in significant improvement in beta cell function and insulin sensitivity along with reduction in anti-diabetes medication. Diabetes remission was mainly seen in those who had duration of diabetes <8.5 years.
代谢手术作为治疗2型糖尿病（T2DM）患者病态肥胖的一种手术方法正日益受到欢迎。本研究的目的是评估代谢手术对肥胖的亚洲印度裔患者β细胞功能、胰岛素敏感性和血糖状态的影响。
这是一项对26例行代谢手术的T2DM患者的前瞻性研究。完全糖尿病缓解定义为术后1年空腹血糖（FPG）<100mg/dl且糖化血红蛋白（HbA1c）<6%，无需使用抗糖尿病药物。在基线、术后6个月和12个月测量人体测量学指标、稳态模型评估胰岛素抵抗（HOMA-IR）、HOMA-胰岛素敏感性、β细胞功能和抗糖尿病药物使用情况。
糖尿病的总病程为10.3±5.4年。1年后，26例T2DM患者中有7例（27%）实现糖尿病缓解，其余19例糖尿病状态有所改善。ROC曲线显示，糖尿病病程<8.5年的患者实现了缓解。从基线到术后6个月和12个月，HOMA-IR显著降低[3.7±1.8 vs 1.4±0.9 vs 1.2±0.6，p<0.001]，HOMA-胰岛素敏感性显著改善[34±17 vs 93±50 vs 112±62，p<0.001]。术后抗糖尿病药物的使用显著减少（p<0.001）。本研究的局限性在于样本量小和随访期仅1年。
在T2DM患者中，代谢手术导致β细胞功能和胰岛素敏感性显著改善，同时抗糖尿病药物减少。糖尿病缓解主要见于糖尿病病程<8.5年的患者。
