Jin Hana, Kim Sang Hyun, Chung Yoona, Park Dae Geun, Kim Yong Jin
Department of Surgery, Bariatric Surgery Center, Soonchunhyang University Hospital Seoul, Soonchunhyang University School of Medicine, Seoul, Korea.
Department of Surgery, H plus Yangji Hospital, Seoul, Korea.
J Metab Bariatr Surg. 2020 Dec;9(2):52-60. doi: 10.17476/jmbs.2020.9.2.52. Epub 2020 Dec 31.
The aim of this study was to report our experiences of sleeve gastrectomy (SG) in obese patients with type 1 diabetes mellitus (T1DM) and to assess its metabolic outcomes through a review of the literature and a meta-analysis.
We conducted a retrospective review of the electronic medical records of all patients who underwent bariatric surgery between January 2008 and February 2019 at a single institution. A literature search was performed using PubMed, Cochrane library, and Embase, and a meta-analysis for each direct comparison between pre- and postoperative groups was performed using the random effects DerSimonian-Laird method.
We identified three obese patients with T1DM who underwent SG. The baseline body mass index (BMI), HbA1c, and total daily insulin dose was 40.8 (37-47.4) kg/m, 7.1% (6%-7.7%), and 92.3 (54-113) units, respectively. After surgery, the BMI and total daily insulin dose reduced to 32.2 (30.2-37.6) kg/m and 22.3 (12-40) units, respectively. However, the HbA1c increased to 7.8% (5.4%-10.8%). In the meta-analysis, the weighted mean reduction in BMI, HbA1c, and total daily insulin dose were 10.69 kg/m (95% CI 7.01-14.37, P<0.00001, I=0%), 0.3% (95% CI -0.10-0.71, P=0.1447, I=0%), and 58.52 units (95% CI 15.96-101.08, P=0.07, I=0%), respectively.
SG showed excellent weight-reducing effects during a short follow-up period in obese patients with T1DM and improved the glycemic control by reducing insulin requirement.
本研究旨在报告我们对肥胖的1型糖尿病（T1DM）患者行袖状胃切除术（SG）的经验，并通过文献回顾和荟萃分析评估其代谢结局。
我们对2008年1月至2019年2月在单一机构接受减重手术的所有患者的电子病历进行了回顾性研究。使用PubMed、Cochrane图书馆和Embase进行文献检索，并采用随机效应DerSimonian-Laird方法对术前和术后组之间的每次直接比较进行荟萃分析。
我们确定了3例接受SG的肥胖T1DM患者。基线体重指数（BMI）、糖化血红蛋白（HbA1c）和每日胰岛素总剂量分别为40.8（37 - 47.4）kg/m²、7.1%（6% - 7.7%）和92.3（54 - 113）单位。术后，BMI和每日胰岛素总剂量分别降至32.2（30.2 - 37.6）kg/m²和22.3（12 - 40）单位。然而，HbA1c升至7.8%（5.4% - 10.8%）。在荟萃分析中，BMI、HbA1c和每日胰岛素总剂量的加权平均降低分别为10.69 kg/m²（95%CI 7.01 - 14.37，P<0.00001，I² = 0%）、0.3%（95%CI -0.10 - 0.71，P = 0.1447，I² = 0%）和58.52单位（95%CI 15.96 - 101.08，P = 0.07，I² = 0%）。
在对肥胖的T1DM患者的短期随访中，SG显示出良好的减重效果，并通过降低胰岛素需求改善了血糖控制。
