Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan.
Johnson & Johnson K.K. Medical Company, Tokyo, Japan.
J Diabetes Investig. 2022 Jan;13(1):74-84. doi: 10.1111/jdi.13631. Epub 2021 Aug 24.
AIMS/INTRODUCTION: To compare glycemic control 1 year after treatment in patients with mildly obese (body mass index 27.5-34.9 kg/m ) type 2 diabetes mellitus who underwent bariatric surgery (BS) to those who received medical treatment (MT) in Japan.
A retrospective study using real-world data was carried out in electronic medical records from a tertiary care hospital and in the Japanese Medical Data Center Inc. claim database from 2008 to 2019. Each patient was propensity score-matched between the BS and the MT group by age, sex, body mass index, glycated hemoglobin and type 2 diabetes mellitus duration, and compared from the index date to the 1 year post-index.
The study included 78 patients in the BS group and 238 patients in the MT group. The mean body mass index in the BS and the MT group was 32.1 and 32.0 kg/m , respectively. In the BS group, the patients underwent either laparoscopic sleeve gastrectomy with or without duodenojejunal bypass. The diabetes remission rate (glycated hemoglobin <6.5% without diabetes medication) at 1 year was 59.0% in the BS group and 0.4% in the MT group (P < 0.0001). Optimal glycemic control of glycated hemoglobin <7.0% was achieved in 75.6% in the BS group and in 29.0% in the MT group (P < 0.0001). The median monthly drug costs for metabolic syndrome decreased from $US126.5 (at baseline) to $US0.0 (at 1 year) in the BS group, whereas it increased from $US52.4 to $US58.3 in the MT group.
BS for mildly obese patients with type 2 diabetes mellitus is more clinically- and cost-effective than MT in Japan.
目的/引言：本研究旨在比较日本轻度肥胖（体重指数 27.5-34.9kg/m²）2 型糖尿病患者接受减重手术（BS）与接受药物治疗（MT）后 1 年的血糖控制情况。
本研究采用回顾性研究，使用来自一家三级医疗机构的电子病历和日本医疗数据中心 Inc. 的理赔数据库中的真实世界数据，于 2008 年至 2019 年期间进行。通过年龄、性别、体重指数、糖化血红蛋白和 2 型糖尿病病程对 BS 和 MT 组的每位患者进行倾向评分匹配，并从指数日期比较至指数后 1 年。
BS 组 78 例患者，MT 组 238 例患者。BS 组和 MT 组的平均体重指数分别为 32.1kg/m²和 32.0kg/m²。BS 组患者接受的手术方式为腹腔镜袖状胃切除术联合或不联合十二指肠空肠旁路术。BS 组患者在 1 年时的糖尿病缓解率（糖化血红蛋白<6.5%且无需使用糖尿病药物）为 59.0%，而 MT 组为 0.4%（P<0.0001）。BS 组患者实现糖化血红蛋白<7.0%的最佳血糖控制率为 75.6%，而 MT 组为 29.0%（P<0.0001）。BS 组患者的代谢综合征每月药物费用中位数从基线时的 126.5 美元（US$）降至 1 年后的 0.0 美元（US$），而 MT 组则从 52.4 美元（US$）增至 58.3 美元（US$）。
与 MT 相比，BS 治疗日本轻度肥胖 2 型糖尿病患者更具临床和成本效益。
