Gupta Mehul, Aggarwal Sandeep, Bhambri Amit, Singla Vitish, Chaudhary Rachna
Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
J Minim Access Surg. 2021 Oct-Dec;17(4):462-469. doi: 10.4103/jmas.JMAS_19_20.
Bariatric surgery, besides causing significant weight reduction, leads to improvement in type 2 diabetes mellitus (T2DM). However, there is a scarcity of data on the prediction of diabetes resolution in non-Western population.
To evaluate the impact of bariatric surgery on T2DM and to assess the accuracy of pre-operative scoring systems in predicting remission.
A tertiary care academic centre, India.
We used a retrospective cohort of all diabetic patients (n = 244) who underwent bariatric surgery at our centre in the past 10 years. The cohort was followed up for diabetes remission, and pre-operative scoring systems were analysed against the observed results.
Of 244 patients, we were able to contact 156 patients. The median period of follow-up was 38 months. The mean body mass index (BMI) of the study group decreased from 45.4 to 33.4 kg/m (%excess BMI loss = 61.2%). The number of patients dependent on oral anti-diabetic pharmacotherapy and on insulin decreased from 133 (85.3%) to 40 (25.6%) and from 31 (19.9%) to 7 (4.5%), respectively. Remission was analysed for 96 patients, who submitted complete biochemical investigations. The median follow-up period for this sub-cohort was 36 months. 38 (39.6%) patients were in complete remission, 15 (15.6%) patients in partial remission and 34 (38.5%) patients showed an improved glycaemic control. The three pre-operative scores, Advanced-DiaRem, DiaRem and ABCD, showed predictive accuracies of 81.1%, 75.6% and 77.8%, respectively.
Besides leading to excess BMI loss of 61.2%, bariatric surgery also resulted in diabetes remission in 55.2% of the patients. Amongst various pre-operative scores, Advanced-DiaRem has the highest predictive accuracy for T2DM remission.
减肥手术除了能显著减轻体重外，还能改善2型糖尿病（T2DM）。然而，关于非西方人群糖尿病缓解预测的数据却很匮乏。
评估减肥手术对T2DM的影响，并评估术前评分系统预测缓解的准确性。
印度的一家三级医疗学术中心。
我们采用回顾性队列研究，纳入了过去10年在我们中心接受减肥手术的所有糖尿病患者（n = 244）。对该队列进行随访以观察糖尿病缓解情况，并将术前评分系统与观察结果进行分析对比。
在244例患者中，我们成功联系到了156例。中位随访期为38个月。研究组的平均体重指数（BMI）从45.4降至33.4 kg/m（超重BMI损失百分比 = 61.2%）。依赖口服降糖药治疗和胰岛素治疗的患者数量分别从133例（85.3%）降至40例（25.6%），从31例（19.9%）降至7例（4.5%）。对96例提交了完整生化检查的患者进行了缓解情况分析。该亚组的中位随访期为36个月。38例（39.6%）患者完全缓解，15例（15.6%）患者部分缓解，34例（38.5%）患者血糖控制得到改善。三种术前评分，即Advanced-DiaRem、DiaRem和ABCD，预测准确率分别为81.1%、75.6%和77.8%。
减肥手术除了使超重BMI损失61.2%外，还使55.2%的患者糖尿病得到缓解。在各种术前评分中，Advanced-DiaRem对T2DM缓解的预测准确率最高。
