Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain; Faculty of Medicine, University of Málaga, Málaga, Spain.
Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.
Diabetes Res Clin Pract. 2023 May;199:110650. doi: 10.1016/j.diabres.2023.110650. Epub 2023 Apr 2.
Metabolic surgery is the most effective therapeutic strategy for the management of type 2 diabetes (T2DM). Several preoperative clinical factors have been associated with T2DM remission after metabolic surgery. However, other potential predictors remain unexplored.
To assess the role of basal (pre-surgery) clinical and biochemical parameters in T2DM remission after metabolic surgery.
A prospective study including 98 patients with T2DM undergoing metabolic surgery was performed. Clinical, anthropometric, and biochemical data were collected at baseline and 1 year following metabolic surgery.
Patients without T2DM remission 1 year after metabolic surgery presented a longer duration of diabetes and higher glycated hemoglobin (HbA1c) levels; a higher percentage of these subjects were using insulin therapy, antihypertensive drugs, and lipid-lowering therapies before metabolic surgery, compared to those patients with T2DM remission. A lower percentage of T2DM remission after metabolic surgery was observed among patients with hypertension/hypercholesterolemia before surgery, compared to those patients without hypertension/hypercholesterolemia (51.7 % vs 86.8 %, p < 0.001, and 38.5 % vs 75 %, p < 0.001, respectively), and among patients with longer duration of diabetes (≥5 years vs <5 years; 44.4 % vs 83 %, respectively; p < 0.001). In the logistic regression model, diabetes duration, basal HbA1c, and the presence of hypertension and hypercholesterolemia before surgery were inversely related to T2DM remission following metabolic surgery, after adjusting for sex, age, waist circumference, and type of surgery.
In a cohort of patients with obesity and T2DM, preoperative hypertension and hypercholesterolemia, together with a longer diabetes duration and higher HbA1c concentrations, were independent predictors of T2DM persistence after metabolic surgery.
代谢手术是治疗 2 型糖尿病（T2DM）的最有效治疗策略。有几项术前临床因素与代谢手术后 T2DM 的缓解相关。然而，其他潜在的预测因素仍未得到探索。
评估代谢手术后 T2DM 缓解的基础（术前）临床和生化参数的作用。
进行了一项包括 98 例 T2DM 患者的前瞻性研究，这些患者接受了代谢手术。在代谢手术后 1 年，收集了临床、人体测量和生化数据。
在代谢手术后 1 年未缓解 T2DM 的患者糖尿病病程较长，糖化血红蛋白（HbA1c）水平较高；与 T2DM 缓解的患者相比，这些患者在接受代谢手术前使用胰岛素治疗、抗高血压药物和降脂药物的比例更高。与没有高血压/高胆固醇血症的患者相比，术前有高血压/高胆固醇血症的患者代谢手术后 T2DM 缓解的比例较低（51.7%比 86.8%，p<0.001 和 38.5%比 75%，p<0.001），且糖尿病病程较长（≥5 年比<5 年；44.4%比 83%）的患者也较低（p<0.001）。在校正性别、年龄、腰围和手术类型后，logistic 回归模型显示，术前糖尿病病程、基础 HbA1c 以及术前高血压和高胆固醇血症与代谢手术后 T2DM 缓解呈负相关。
在肥胖和 T2DM 患者队列中，术前高血压和高胆固醇血症，以及较长的糖尿病病程和较高的 HbA1c 浓度，是代谢手术后 T2DM 持续存在的独立预测因素。
