Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.
Department of Biomedical Sciences, Inha University College of Medicine, Incheon, Korea.
Medicine (Baltimore). 2022 Sep 9;101(36):e30309. doi: 10.1097/MD.0000000000030309.
This study investigated the antidiabetic outcomes after gastrectomy with long-limb RY reconstruction (LRYR) and the prognostic factors for remission after 1 year in patients with type 2 diabetes (T2DM) and gastric cancer. In 25 Koreans with T2DM and gastric cancer, plasma glucose and insulin levels were measured during a 75 g oral glucose tolerance test, before and 1 week after gastrectomy with LRYR. Patients were examined after 1 year and we defined glycemic control as "remission" when the HbA1c level after 1 year was <6.0% without medication. One year after surgery, 12 patients achieved HbA1c < 6.0% without medication. Among the preoperative indices, the duration of diabetes was shorter in the remission group than that in the non-remission group (median 2.0 [0-6.5] years vs 7.0 [4.5-10.0] years, P = .023). At 1 week after surgery, significant improvements in fasting, 30 minutes, 60 minutes, 90 minutes stimulated glucose levels and insulin resistance (HOMA-IR and Matsuda index) were found only in the remission group. The multivariable logistic regression analysis results showed that higher 30 minutes stimulated glucose level and HOMA-IR index at 1 week after surgery were independent factors for lower odds of 1-year diabetes remission. Shorter duration of diabetes and early postoperative improvements in 30 minutes stimulated glucose level and HOMA-IR were important determinants of long-term antidiabetic outcomes after gastrectomy with LRYR in patients with T2DM and gastric cancer.
这项研究调查了胃切除术后长肢 Roux-en-Y 重建（LRYR）对 2 型糖尿病（T2DM）合并胃癌患者的降糖效果，以及术后 1 年缓解的预测因素。在 25 名 T2DM 合并胃癌的韩国患者中，在胃切除术后 1 周内进行了 75g 口服葡萄糖耐量试验，测量了空腹和胰岛素水平。术后 1 年进行检查，我们将 HbA1c 水平在 1 年后 <6.0%且无需药物定义为血糖控制“缓解”。术后 1 年，12 名患者 HbA1c<6.0%且无需药物。在术前指标中，缓解组糖尿病病程较非缓解组短（中位数 2.0 [0-6.5] 年比 7.0 [4.5-10.0] 年，P =.023）。术后 1 周时，仅在缓解组观察到空腹、30 分钟、60 分钟、90 分钟刺激血糖水平和胰岛素抵抗（HOMA-IR 和 Matsuda 指数）显著改善。多变量逻辑回归分析结果表明，术后 1 周时 30 分钟刺激血糖水平和 HOMA-IR 指数较高是 1 年糖尿病缓解可能性较低的独立因素。糖尿病病程较短和术后 30 分钟刺激血糖水平和 HOMA-IR 早期改善是 T2DM 合并胃癌患者胃切除术后 LRYR 长期降糖效果的重要决定因素。
