Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.
Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium.
Sci Rep. 2024 Apr 8;14(1):8211. doi: 10.1038/s41598-024-59048-w.
Although bariatric surgery is an effective treatment for type 2 diabetes by inducing weight loss and augmenting gut hormone secretion, the immediate effect on beta-cell function itself remains to be elucidated in type 2 diabetes. Therefore, a prospective, randomized trial was performed in 30 patients with insulin-treated type 2 diabetes and a body mass index ≥ 35 kg/m. Patients were randomly assigned (1:1:1) to Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in combination with protein-sparing modified fast (PSMF), or to PSMF alone. Eu- and hyperglycemic clamps were performed before and 3 weeks after surgery and/or PSMF initiation. The primary outcome was the evolution of insulin sensitivity and beta-cell function after surgery, calculated using the composite measures of glucose disposal rate, insulin secretion rate, and disposition index (DI). Results revealed that markers of insulin sensitivity increased similarly in all arms (p = 0.43). A higher marker for maximal beta-cell function was observed when comparing SG to PSMF (p = 0.007). The DI showed a clear positive evolution after RYGB and SG, but not after PSMF alone. Altogether, these findings indicate that bariatric surgery results in an immediate beta-cell function recovery in insulin-treated type 2 diabetes.
尽管减重手术通过诱导体重减轻和增加肠道激素分泌对 2 型糖尿病有效，但它对 2 型糖尿病患者β细胞功能本身的即时影响仍需阐明。因此，对 30 例接受胰岛素治疗的 2 型糖尿病且 BMI≥35kg/m2 的患者进行了一项前瞻性、随机试验。患者被随机分配（1:1:1）接受 Roux-en-Y 胃旁路术（RYGB）或袖状胃切除术（SG）联合蛋白节约快速减肥法（PSMF），或仅接受 PSMF。在手术前和手术后 3 周或 PSMF 开始前进行了正葡萄糖和高葡萄糖钳夹试验。主要结局是手术后胰岛素敏感性和β细胞功能的演变，通过葡萄糖处置率、胰岛素分泌率和处置指数（DI）的综合指标来计算。结果显示，所有组的胰岛素敏感性标志物均相似地增加（p=0.43）。与 PSMF 相比，SG 组观察到最大β细胞功能的标志物更高（p=0.007）。RYGB 和 SG 后 DI 明显呈正性演变，但 PSMF 单独治疗后则没有。总的来说，这些发现表明减重手术可立即恢复接受胰岛素治疗的 2 型糖尿病患者的β细胞功能。
