Department of General and Visceral Surgery, Center of Metabolic Surgery, Hospital zum Heiligen Geist, Lange Str. 4-6, 60311, Frankfurt, Germany.
Marien Hospital Herne, Department of Urology, Center of Uro-Oncology, Ruhr University of Bochum, Hölkeskampring 40, 44625, Herne, Germany.
Obes Surg. 2022 Oct;32(10):3340-3350. doi: 10.1007/s11695-022-06223-5. Epub 2022 Aug 8.
This study investigates the long-term effects of biliopancreatic diversion with duodenal switch (BPD-DS) on patients with advanced type 2 diabetes mellitus (T2DM) while paying special attention to preoperative diabetes severity.
A retrospective analysis was conducted using prospective and current data on patients who underwent an open BPD-DS 6-12 years ago. Patients were stratified according to preoperative diabetes severity into 4 groups (group 1: oral antidiabetic drugs only; group 2: insulin < 5 years; group 3: insulin 5-10 years; group 4: insulin > 10 years). The primary endpoint was T2DM remission rate 6-12 years after BPD-DS as a function of preoperative diabetes severity.
Ninety-one patients with advanced T2DM were included. Sixty-two patients were available for follow-up (rate of 77%). Follow-up was performed (mean ± SD) 8.9 ± 1.3 years after surgery. Glycated hemoglobin (HbA) levels were 9.4 ± 2.0% before surgery and decreased to 5.1 ± 0.8% after 1 year and 5.4 ± 1.0% after 6-12 years. Insulin discontinuation rate after surgery as well as the rate of long-term remission decreased steadily from groups 1 to 4, while long-term mortality increased. T2DM remission rates were 93%, 88%, 45%, and 40% in groups 1, 2, 3, and 4, respectively. Late relapse of T2DM occurred in 3 patients (5%).
BPD-DS causes a rapid and long-lasting normalization of glycemic metabolism in patients with advanced T2DM. T2DM remission rate after 6-12 years varies significantly (from 40% to more than 90%) and is highly dependent on preoperative diabetes severity.
本研究特别关注术前糖尿病严重程度，旨在探讨胆胰分流十二指肠转位术（BPD-DS）对晚期 2 型糖尿病（T2DM）患者的长期影响。
使用前瞻性和当前数据对 6-12 年前接受开放 BPD-DS 的患者进行回顾性分析。根据术前糖尿病严重程度将患者分为 4 组（组 1：仅口服抗糖尿病药物；组 2：胰岛素<5 年；组 3：胰岛素 5-10 年；组 4：胰岛素>10 年）。主要终点是 BPD-DS 后 6-12 年 T2DM 缓解率，作为术前糖尿病严重程度的函数。
共纳入 91 例晚期 T2DM 患者。62 例患者可进行随访（占 77%）。术后随访（平均±标准差）时间为 8.9±1.3 年。术前糖化血红蛋白（HbA）水平为 9.4±2.0%，术后 1 年降至 5.1±0.8%，术后 6-12 年降至 5.4±1.0%。术后胰岛素停药率以及长期缓解率从组 1 到组 4 逐渐下降，而长期死亡率增加。组 1、2、3 和 4 的 T2DM 缓解率分别为 93%、88%、45%和 40%。3 例（5%）患者发生 T2DM 晚期复发。
BPD-DS 可使晚期 T2DM 患者的血糖代谢迅速且持久正常化。6-12 年后 T2DM 缓解率差异显著（40%至 90%以上），且高度依赖术前糖尿病严重程度。
