Ma Subo, Wang Lun, Chen Jia, Zhao Yuhui, Jiang Tao
Department of Weight Loss and Metabolic Surgery, China-Japan Union Hospital of Jilin University, Jilin, China.
Department of Critical Care Medicine, Shaoxing People's Hospital, Shaoxing, China.
Asian J Surg. 2022 Jan;45(1):315-319. doi: 10.1016/j.asjsur.2021.06.001. Epub 2021 Jul 8.
The effect of laparoscopic sleeve gastrectomy (LSG) in the treatment of type 2 diabetes (T2D) patients with body mass index (BMI is calculated by dividing weight in kilograms by height in meters squared) higher than 25 kg/m but lower than 32.5 kg/m, especially in East Asian population characterized by abdominal obesity, are still unclear. This study aims to explore the effect of LSG in T2D patients with BMI higher than 25 kg/m but lower than 32.5 kg/m.
A total of 49 T2D patients with BMI(25-32.5 kg/m) treated successfully with LSG were included in our study. The effect of LSG on T2D remission outcomes at 12 and 24 months after operation was analyzed.
All patients were treated successfully with LSG without conversion. The mean preoperative body weight,BMI, fasting plasma glucose, glycosylated hemoglobin (A1c) and fasting C-peptide were 81.7 ± 10.0 kg, 29.1 ± 2.4 kg/m, 10.4 ± 3.9 mmol/L,8.2 ± 1.5%, and 2.3 ± 1.1 nmol/L,respectively.The age, duration of diabetes and ABCD score were 48.6 ± 9.6 years,6.6 ± 5.1 years, and 2.9 ± 1.5. The mean fasting plasma glucose,A1c, and C-peptide levels were significantly decreased at 12 and 24 months after operation. At postoperative 24 months, 18 out of 49 patients (36.7%) reached diabetes complete remission (A1c levels≤6.0%).14 out of 49 patients (28.6%) reached partial remission (6.0% < A1c levels<6.5%). 8 out of 49 patients (16.3%) reached notable improvement (6.5% < A1c levels<7%). At 24 months after LSG, the complete remission rate of T2D patients with a BMI of 25-27.5 kg/m was 35.3%, the complete remission rate of patients with a BMI of 27.5-30 kg/m was 11.1%, and the complete remission rate of patients with a BMI of 30-32.5 kg/m was 47.8%.At postoperative 24 months, the complete remission rate of T2D patients with ABCD score≤2 was 5.0%, the complete remission rate of patients with ABCD score 3 to 4 was 52.4%, and the complete remission rate of patients with ABCD score≥5 was 75.0%.
Our study demonstrates that LSG could result in a significant effect on T2D in patients with BMI 30-32.5 kg/m. In addition, our study indicates that higher ABCD score can predict a better diabetes remission outcome in diabetes patients with BMI ≤32.5 kg/m.
腹腔镜袖状胃切除术（LSG）对体重指数（BMI，通过体重千克数除以身高米数的平方计算）高于25kg/m但低于32.5kg/m的2型糖尿病（T2D）患者的治疗效果，尤其是在以腹型肥胖为特征的东亚人群中，仍不明确。本研究旨在探讨LSG对BMI高于25kg/m但低于32.5kg/m的T2D患者的治疗效果。
本研究纳入了49例成功接受LSG治疗的BMI（25 - 32.5kg/m）的T2D患者。分析了LSG对术后12个月和24个月T2D缓解结局的影响。
所有患者均成功接受LSG治疗，无中转情况。术前平均体重、BMI、空腹血糖、糖化血红蛋白（A1c）和空腹C肽分别为81.7±10.0kg、29.1±2.4kg/m、10.4±3.9mmol/L、8.2±1.5%和2.3±1.1nmol/L。年龄、糖尿病病程和ABCD评分分别为48.6±9.6岁、6.6±5.1年和2.9±1.5。术后12个月和24个月时，平均空腹血糖、A1c和C肽水平均显著降低。术后24个月时，49例患者中有18例（36.7%）达到糖尿病完全缓解（A1c水平≤6.0%）。49例患者中有14例（28.6%）达到部分缓解（6.0%＜A1c水平＜6.5%）。49例患者中有8例（16.3%）达到显著改善（6.5%＜A1c水平＜7%）。LSG术后24个月时，BMI为25 - 27.5kg/m的T2D患者完全缓解率为35.3%，BMI为27.5 - 30kg/m的患者完全缓解率为11.1%，BMI为30 - 32.5kg/m的患者完全缓解率为47.8%。术后24个月时，ABCD评分≤2的T2D患者完全缓解率为5.0%，ABCD评分为3至4的患者完全缓解率为52.4%，ABCD评分≥5的患者完全缓解率为75.0%。
我们的研究表明，LSG对BMI为30 - 32.5kg/m的T2D患者有显著疗效。此外，我们的研究表明，较高的ABCD评分可预测BMI≤32.5kg/m的糖尿病患者有更好的糖尿病缓解结局。
