Zhang Ning-Jing, Fu Yu-Zhe, Shan Xiao-Dong, Zhang Ning, Sun Xi-Tai, Chu Xue-Hui, Bi Yan, Zhu Da-Long, Feng Wen-Huan
Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
Department of Endocrinology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
Diabetes Ther. 2021 May;12(5):1429-1444. doi: 10.1007/s13300-021-01027-9. Epub 2021 Mar 19.
The aim of this study was to clarify the efficacy and safety of metabolic surgery in Chinese patients with type 2 diabetes mellitus (T2DM) and a body mass index (BMI) of 27.5-32.5 kg/m.
A total of 99 patients with T2DM were enrolled in this retrospective cohort study. Of these patients, 53 had a BMI of 27.5-32.5 kg/m and had undergone metabolic surgery (n = 21) or were on conventional antidiabetic therapy (n = 32)]; 46 had a BMI ≥ 32.5 kg/m and all had undergone metabolic surgery. Primary endpoints included the triple endpoint [hemoglobin A1c < 6.5%, low-density lipoprotein cholesterol (LDL-C) < 2.6 mmol/L, and systolic blood pressure (SBP) < 130 mmHg] and successful weight loss 1 year later. Remission of diabetes, glucose and lipid metabolism, medication usage, and adverse events were evaluated.
Of patients with BMI 27.5-32.5 kg/m undergoing metabolic surgery, 33.33% achieved the composite endpoints, and 100% achieved successful weight loss. This result was similar to that in patients with BMI ≥ 32.5 and better than those with BMI 27.5-32.5 kg/m receiving conventional antidiabetic therapy. A significant and similar reduction in BMI, waist circumference, SBP, serum LDL-C, hemoglobin A1c, and uric acid, as well as similar frequency postoperative adverse events, were confirmed in both metabolic surgery groups. Patients with BMI 27.5-32.5 kg/m who had undergonemetabolic surgery showed more metabolic improvement than those only receiving medications but they experienced more adverse events.
A BMI cutoff of 27.5 kg/m for metabolic surgery may be suitable for Chinese patients with T2DM.
本研究旨在阐明代谢手术对中国2型糖尿病（T2DM）且体重指数（BMI）为27.5至32.5kg/m²患者的疗效和安全性。
本回顾性队列研究共纳入99例T2DM患者。其中，53例BMI为27.5至32.5kg/m²，接受了代谢手术（n = 21）或接受传统抗糖尿病治疗（n = 32）；46例BMI≥32.5kg/m²，均接受了代谢手术。主要终点包括三联终点[糖化血红蛋白<6.5%、低密度脂蛋白胆固醇（LDL-C）<2.6mmol/L和收缩压（SBP）<130mmHg]以及1年后成功减重。评估糖尿病缓解情况、糖脂代谢、药物使用情况及不良事件。
BMI为27.5至32.5kg/m²接受代谢手术的患者中，33.33%达到复合终点，100%成功减重。该结果与BMI≥32.5的患者相似，且优于BMI为27.5至32.5kg/m²接受传统抗糖尿病治疗的患者。两个代谢手术组的BMI、腰围、SBP、血清LDL-C、糖化血红蛋白和尿酸均有显著且相似的降低，术后不良事件发生率也相似。BMI为27.5至32.5kg/m²接受代谢手术的患者比仅接受药物治疗的患者代谢改善更明显，但不良事件更多。
对于中国T2DM患者，代谢手术的BMI切点为27.5kg/m²可能是合适的。
