Department of Metabolic and Bariatric Surgery, The Third Xiangya Hospital of Central South University, 138 Tongzipo Rd, Yuelu District, Changsha, 410013, China.
Department of General Surgery, The China-Japan Friendship Hospital, Beijing, China.
J Endocrinol Invest. 2022 Sep;45(9):1729-1740. doi: 10.1007/s40618-022-01811-9. Epub 2022 May 21.
Roux-en-Y gastric bypass (RYGB) has been widely reported to be safe and feasible, and has a powerful effect on improving metabolism and weight loss in patients with a high body mass index (BMI). A few studies have focused on the comparison of RYGB with medical treatment in type 2 diabetes (T2D) patients with a lower BMI.
To compare the metabolic effects and safety of RYGB versus medical treatment during a 2 years follow-up in T2D patients with a BMI of 25 to 32.5 kg/m.
This retrospective and multicenter cohort study participants were extracted from the T2D patients with a lower BMI (25-32.5 kg/m) from three bariatric centers between 2009 and 2018. Propensity score matching (PSM) was used to minimize bias, and each patient in the surgical group was matched 1:2 to the patients in the medical group with the closest propensity score. Finally, 71 patients who received RYGB and 142 patients who underwent medical treatment with a 2 years follow-up were enrolled to compare the effects of RYGB and medical treatment. The primary endpoint was achievement of the triple endpoint (the simultaneous achievement of hemoglobin A1c (HbA1c) < 7.0%, fasting low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL (2.6 mmol/L), and systolic blood pressure (SBP) < 130 mmHg at the year-1 visit). Changes in weight, BMI, medication usage, complications, and adverse events were assessed.
In total, 213 patients (mean age of 47.4 ± 9.5 years, 70.4% male, mean BMI of 28.6 ± 2.2 kg/m) were included in this study. At the end of the first year, 17 patients (23.9%) in the surgical group and 10 (7.0%) in the medical group had achieved the composite triple endpoint (OR 4.64; 95% CI 1.82-11.81; p = 0.001). Additionally, 43 patients (60.6%) in the surgical group and 11 patients (19.7%) in the medical group experienced remission of T2D. However, more complications were observed in the surgical group (36 vs. 22, p < 0.01).
Among T2D patients with a BMI between 25.0 and 32.5 kg/m, RYGB was more effective than medical treatment in resolving metabolic disorders and also resulted in more complications. The risk for complications should be considered in the clinical decision-making process for T2D patients with a low BMI.
Roux-en-Y 胃旁路术（RYGB）已被广泛报道为安全且可行的，并且对改善高体重指数（BMI）患者的代谢和体重减轻具有强大的作用。一些研究集中在 RYGB 与 BMI 较低的 2 型糖尿病（T2D）患者的药物治疗比较上。
比较 RYGB 与药物治疗在 BMI 为 25 至 32.5kg/m2 的 T2D 患者 2 年随访期间的代谢效果和安全性。
本回顾性多中心队列研究从 2009 年至 2018 年间的三个减重中心的 BMI 较低（25-32.5kg/m2）的 T2D 患者中提取参与者。采用倾向评分匹配（PSM）以最小化偏差，并且手术组中的每个患者与药物治疗组中最接近的倾向评分的患者 1:2 匹配。最终，纳入 71 例接受 RYGB 治疗和 142 例接受药物治疗且随访 2 年的患者，比较 RYGB 和药物治疗的效果。主要终点是达到三重终点（同时实现糖化血红蛋白（HbA1c）<7.0%，空腹低密度脂蛋白胆固醇（LDL-C）<100mg/dL（2.6mmol/L），和收缩压（SBP）<130mmHg在第 1 年就诊时）。评估体重、BMI、药物使用、并发症和不良事件的变化。
共有 213 例患者（平均年龄 47.4±9.5 岁，70.4%为男性，平均 BMI 为 28.6±2.2kg/m）纳入本研究。在第 1 年末，手术组有 17 例（23.9%）和药物治疗组有 10 例（7.0%）患者达到复合三重终点（OR 4.64；95%CI 1.82-11.81；p=0.001）。此外，手术组有 43 例（60.6%）和药物治疗组有 11 例（19.7%）患者的 T2D 缓解。然而，手术组观察到更多的并发症（36 例比 22 例，p<0.01）。
在 BMI 为 25.0 至 32.5kg/m2 的 T2D 患者中，RYGB 比药物治疗在解决代谢紊乱方面更有效，但也导致更多的并发症。对于 BMI 较低的 T2D 患者，应在临床决策过程中考虑并发症风险。
