Division of Foregut Surgery, Korea University College of Medicine, Seoul, Korea; Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Korea.
BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Korea.
J Am Coll Surg. 2021 Jun;232(6):973-981.e2. doi: 10.1016/j.jamcollsurg.2021.03.019. Epub 2021 Apr 5.
We investigated whether preoperative clinical parameters predict diabetes remission and relapse after conventional gastrectomy for cancer and whether postoperative weight changes influence diabetes remission and relapse.
This study included 5,150 patients with diabetes who underwent gastrectomy for cancer from 2004 to 2014. Diabetes remission was defined in 3 ways, according to postoperative antidiabetic medication and fasting plasma glucose (FPG) levels. Diabetes relapse was defined as reinitiating antidiabetic medication among patients in diabetes remission.
Six predictors (higher body mass index [BMI], total gastrectomy, younger age, FPG levels, number of oral hypoglycemic agents [OHAs], and no insulin use) of diabetes remission increased the likelihood of remission by >13-fold (odds ratio [OR], 13.67; 95% confidence interval [CI], 8.65‒19.11). Three factors (younger age, lower FPG levels, and use of only 1 OHA) predicted a 58% decreased likelihood of diabetes relapse (hazard ratio, 0.42; 95% CI 0.35‒0.48). The lowest interval of postoperative BMI decrease (<-20%) showed a >3-fold increased likelihood of diabetes remission than the highest interval (≥-5%; OR 3.14; 95% CI 2.08‒4.75), independent of baseline BMI.
Six variables (BMI, type of gastrectomy, age, FPG levels, number of OHAs used, and insulin use/non-use), and 3 variables (age, FPG levels, number of OHAs used) significantly predict diabetes remission and relapse after gastrectomy for cancer, respectively. Greater postoperative weight decrease may increase the likelihood of diabetes remission, independent of baseline weight. Our results may serve as a basis for the establishment of diabetes and weight management strategies after conventional gastrectomy for cancer.
本研究旨在探讨术前临床参数是否可预测常规胃癌根治术后糖尿病的缓解和复发，以及术后体重变化是否影响糖尿病的缓解和复发。
本研究纳入了 2004 年至 2014 年间接受胃癌根治术且合并糖尿病的 5150 例患者。根据术后降糖药物及空腹血糖（FPG）水平，将糖尿病缓解定义为 3 种情况。糖尿病复发定义为缓解期患者重新开始使用降糖药物。
6 个预测糖尿病缓解的因素（较高的体质指数[BMI]、全胃切除术、年龄较小、FPG 水平、口服降糖药[OHA]的种类、未使用胰岛素）使缓解的可能性增加了 13 倍以上（优势比[OR]，13.67；95%置信区间[CI]，8.65‒19.11）。3 个因素（年龄较小、FPG 水平较低、仅使用 1 种 OHA）预测糖尿病复发的可能性降低了 58%（风险比，0.42；95%CI，0.35‒0.48）。术后 BMI 下降幅度最低的（<‒20%）比最高的（≥‒5%）缓解可能性增加了 3 倍以上（OR，3.14；95%CI，2.08‒4.75），且独立于基线 BMI。
6 个变量（BMI、胃切除术类型、年龄、FPG 水平、OHA 使用种类、胰岛素使用/不使用）和 3 个变量（年龄、FPG 水平、OHA 使用种类）分别显著预测胃癌根治术后糖尿病的缓解和复发。术后体重下降幅度越大，糖尿病缓解的可能性越大，且与基线体重无关。我们的研究结果可为制定常规胃癌根治术后糖尿病和体重管理策略提供依据。
