Shoda Katsutoshi, Kubota Takeshi, Ushigome Emi, Konishi Hirotaka, Shiozaki Atsushi, Fujiwara Hitoshi, Okamoto Kazuma, Kawaguchi Yoshihiko, Akaike Hidenori, Fukui Michiaki, Ichikawa Daisuke, Otsuji Eigo
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 6028566, Japan.
First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan.
Surg Today. 2022 Jun;52(6):889-895. doi: 10.1007/s00595-021-02404-4. Epub 2021 Nov 24.
Recent studies have highlighted the importance of understanding trends in blood glucose levels. We examined the differences in blood glucose fluctuations according to the reconstruction method used after distal gastrectomy (DG) in patients with non-diabetic gastric cancer (GC).
Sixty-one patients who underwent DG followed by either Billroth 1 (B1) or Roux-en-Y (R-Y) reconstruction were enrolled in this study. We used flash continuous glucose monitoring (CGM), a new technique for assessing glycemic control, to document the post-gastrectomy glycemic profile. Immediately before discharge, a CGM sensor was placed subcutaneously to evaluate blood glucose trends for 2 weeks.
The coefficient of variation of glucose levels was significantly higher in the Roux-en-Y (R-Y) group than in the Billroth I (B-I) group (p = 0.0260). The time below range (TBR, glucose levels of < 70 mg/dL) was also significantly higher in the R-Y group (p = 0.0115). Logistic regression analysis revealed that preoperative casual glucose levels of < 100 mg/dL and R-Y reconstruction were independently correlated with risk factors for a postoperative nocturnal TBR of > 30% (p = 0.006 and 0.042, respectively).
Our findings provide new insights into the post-DG reconstruction method selected for patients with non-diabetic gastric cancer by assessing postoperative blood glucose fluctuations using flash CGM.
近期研究强调了了解血糖水平趋势的重要性。我们研究了非糖尿病胃癌（GC）患者远端胃切除术（DG）后采用不同重建方法时血糖波动的差异。
本研究纳入了61例行DG并采用毕罗Ⅰ式（B1）或 Roux-en-Y（R-Y）重建术的患者。我们使用快速连续血糖监测（CGM）这一评估血糖控制的新技术来记录胃切除术后的血糖情况。出院前，皮下植入CGM传感器以评估2周的血糖趋势。
Roux-en-Y（R-Y）组的血糖水平变异系数显著高于毕罗Ⅰ式（B-I）组（p = 0.0260）。R-Y组血糖低于范围的时间（TBR，血糖水平<70 mg/dL）也显著更高（p = 0.0115）。逻辑回归分析显示，术前随机血糖水平<100 mg/dL和R-Y重建术与术后夜间TBR>30%的危险因素独立相关（分别为p = 0.006和0.042）。
我们的研究结果通过使用快速CGM评估术后血糖波动，为非糖尿病胃癌患者选择DG后的重建方法提供了新的见解。
