专科 2 型糖尿病门诊严重肥胖症：澳大利亚回顾性队列研究。
Severe obesity in a specialist type 2 diabetes outpatient clinic: an Australian retrospective cohort study.
机构信息
School of Medicine, Western Sydney University, Campbelltown, New South Wales, 2560, Australia.
Macarthur Diabetes Service, Camden and Campbelltown Hospitals, Campbelltown, New South Wales, 2560, Australia.
出版信息
BMC Endocr Disord. 2021 Mar 24;21(1):55. doi: 10.1186/s12902-021-00722-9.
BACKGROUND
Obesity is a major risk factor for the development of type 2 diabetes (T2DM) and its complications. Significant weight loss has been shown to improve glycaemia in people with T2DM and obesity. National and international guidelines recommend considering bariatric surgery for body mass index (BMI) ≥ 35 kg/m. We assessed the proportion of people with T2DM meeting criteria for surgery, how many had been offered a bariatric/obesity service referral, and compared the characteristics of people with BMI ≥ 35 kg/m and BMI < 35 kg/m.
METHODS
Retrospective data were collected for all people with T2DM aged ≥18 years, attending a hospital specialist diabetes outpatient service over three calendar years, 2017-2019.
RESULTS
Of 700 people seen in the service, 291 (42%) had BMI ≥ 35 kg/m (the "BMI ≥ 35 group") and met criteria for bariatric surgery, but only 54 (19%) of them were offered referral to an obesity service. The BMI ≥ 35 group was younger than those with a BMI < 35 kg/m (56.1 ± 14.8 vs 61.4 ± 14.6 years, p < 0.001) (mean ± SD), with similar diabetes duration (11.0 ± 9.0 vs 12.3 ± 8.9 years, p = 0.078), and there was no significant difference in initial HbA1c (75 ± 27 vs 72 ± 26 mmol/mol, p = 0.118) (9.0 ± 2.5 vs 8.7 ± 2.4%) or proportion treated with insulin (62% vs 58%). There was more GLP1 agonist use in the BMI ≥ 35 group (13% vs 7%, p = 0.003) but similar rates of SGLT2 inhibitor use (25% vs 21%, p = 0.202). The BMI ≥ 35 group received more new medication and/or dose adjustments (74% vs 66%, p = 0.016). Only 29% in the BMI ≥ 35 kg group achieved HbA1c < 53 mmol/mol (7.0%).
CONCLUSIONS
In spite of frequently meeting the criteria for bariatric surgery and not achieving glycaemic targets, people with T2DM in this specialist clinic received limited medical or surgical management of their obesity. This study suggests opportunities for improvement in care of people with T2DM at several levels including increased referrals from T2DM services to weight management/bariatric services, as well as an increased use of GLP1 agonists and SGLT2 inhibitors where appropriate. Our data support the need to prioritise obesity management in the treatment of type 2 diabetes.
背景
肥胖是 2 型糖尿病（T2DM）及其并发症发展的主要危险因素。大量研究表明，体重显著减轻可改善 T2DM 合并肥胖患者的血糖水平。国家和国际指南建议对于 BMI≥35kg/m²的患者，考虑进行减重手术。本研究评估了符合手术标准的 T2DM 患者比例、有多少患者接受了减重/肥胖服务转诊，并比较了 BMI≥35kg/m²和 BMI<35kg/m²患者的特征。
方法
回顾性收集了 2017-2019 年期间在一家医院专科糖尿病门诊就诊的所有≥18 岁的 T2DM 患者的数据。
结果
在该服务中心就诊的 700 名患者中，有 291 名（42%）BMI≥35kg/m²（“BMI≥35 组”）且符合减重手术标准，但只有 54 名（19%）患者被转介至肥胖服务中心。BMI≥35 组患者比 BMI<35kg/m²组患者年轻（56.1±14.8 岁 vs 61.4±14.6 岁，p<0.001），两组患者的糖尿病病程相似（11.0±9.0 年 vs 12.3±8.9 年，p=0.078），初始 HbA1c（75±27mmol/mol vs 72±26mmol/mol，p=0.118）（9.0±2.5% vs 8.7±2.4%）或胰岛素治疗比例（62% vs 58%）无显著差异。BMI≥35 组 GLP1 激动剂使用率更高（13% vs 7%，p=0.003），但 SGLT2 抑制剂使用率相似（25% vs 21%，p=0.202）。BMI≥35 组患者接受更多的新药物和/或剂量调整（74% vs 66%，p=0.016）。BMI≥35kg/m²组仅 29%的患者达到 HbA1c<53mmol/mol（7.0%）。
结论
尽管经常符合减重手术标准且血糖目标未达标，但该专科门诊的 T2DM 患者接受的肥胖医学或手术治疗有限。这项研究表明，在多个层面都有改善 T2DM 患者护理的机会，包括增加 T2DM 服务向体重管理/减重服务的转诊，以及在适当情况下增加 GLP1 激动剂和 SGLT2 抑制剂的使用。我们的数据支持在 2 型糖尿病治疗中优先考虑肥胖管理。
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