Assistance Publique-Hôpitaux de Paris, Nutrition Department, Pitié-Salpêtrière Hospital, CRNH Ile de France, Sorbonne Université, Batiment IE3M, 6th floor, 46-83 Boulevard de l'Hôpital, 75013, Paris, France.
Assistance Publique-Hôpitaux de Paris, Cochin Hospital, Department of Diabetology, Paris Descartes University, Paris, France.
Obes Surg. 2021 Mar;31(3):1046-1054. doi: 10.1007/s11695-020-05075-1. Epub 2020 Nov 4.
INTRODUCTION/ PURPOSE: Sleeve gastrectomy (SG), the most frequently performed bariatric procedure, induces marked weight-loss, but with high inter-individual variability. Since type 2 diabetes (T2D) negatively impacts weight-loss outcomes after Roux-en-Y gastric bypass (RYGB), we herein aimed to evaluate whether and how T2D status may influence weight-loss and body composition changes in individuals with or without T2D after SG.
We retrospectively included individuals with obesity operated from SG and prospectively followed at our center: 373 patients including 152 with T2D (40%). All subjects' clinical characteristics were collected before and during 4 years of follow-up post-SG. Linear mixed models were applied to analyze weight-loss trajectories post-surgery.
Compared to individuals with obesity but no T2D, those with T2D before SG displayed lower weight-loss at 1 year (21 vs. 27% from baseline, p < 10). This difference was accentuated in patients with poorer glucose control (HbA1c > 7%) at baseline. Furthermore, patients with T2D underwent less favorable body composition changes at 1-year post-SG compared to individuals without T2D (% fat mass reduction: 28 vs. 37%, p < 10 respectively).
When undergoing SG, subjects with obesity and T2D who have poor pre-operative glycemic control display reduced weight-loss and less improvement in body composition compared to patients with obesity but without T2D. This result suggests that glycemic control prior to surgery is important to take into account for the outcome of bariatric surgery.
引言/目的：袖状胃切除术（SG）是最常施行的减重手术，可显著减轻体重，但个体间存在较大差异。由于 2 型糖尿病（T2D）会对 Roux-en-Y 胃旁路术（RYGB）后的减重效果产生负面影响，我们旨在评估 T2D 状态是否以及如何影响有或无 T2D 的个体在 SG 后的减重和身体成分变化。
我们回顾性纳入在我院接受 SG 治疗的肥胖患者，并前瞻性随访：共纳入 373 例患者，其中 152 例患有 T2D（40%）。所有患者在 SG 术前和术后 4 年的随访中收集了临床特征。采用线性混合模型分析术后的减重轨迹。
与无 T2D 的肥胖患者相比，SG 术前患有 T2D 的患者在术后 1 年的减重效果更差（从基线下降 21%比 27%，p<0.01）。在基线时 HbA1c>7%的血糖控制较差的患者中，这种差异更为明显。此外，与无 T2D 的患者相比，T2D 患者在 SG 术后 1 年的身体成分变化更差（体脂减少百分比：28%比 37%，p<0.01）。
在接受 SG 治疗时，术前血糖控制不佳的肥胖合并 T2D 患者的减重效果和身体成分改善情况均差于肥胖但无 T2D 的患者。这一结果表明，术前血糖控制对于减重手术的结果非常重要，应予以重视。
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