Unidade de Obesidade, Disciplina de Endocrinologia E Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), R. Dr. Ovídio Pires de Campos, 225 - Cerqueira César, São Paulo, SP, 05403-010, Brazil.
Unidade de Cirurgia Bariátrica E Metabólica, Disciplina de Cirurgia Do Aparelho Digestivo E Coloproctologia, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), R. Dr. Ovídio Pires de Campos, 225 - Cerqueira César, São Paulo, SP, 05403-010, Brazil.
Obes Surg. 2024 Aug;34(8):2789-2798. doi: 10.1007/s11695-024-07358-3. Epub 2024 Jul 13.
To evaluate glycemic variability (GV) using continuous glucose monitoring (CGM) in individuals with and without type 2 diabetes mellitus (T2DM) undergoing Roux-en-Y gastric bypass (RYGB).
This prospective cohort study compared the CGM data of fourteen patients with T2DM (n = 7) and without T2DM (n = 7) undergoing RYGB. After 6 months, these patients were compared to a non-operative control group (n = 7) matched by BMI, sex, and age to the T2DM group.
Fourteen patients underwent RYGB, with a mean BMI of 46.9 ± 5.3 kg/m and an average age of 47.9 ± 8.9 years; 85% were female. After 6 months post-surgery, the total weight loss (TWL) was 27.1 ± 6.3%, with no significant differences between the groups. Patients without diabetes had lower mean interstitial glucose levels (81 vs. 94 and 98 mg/dl, p < 0.01) and lower glucose management indicator (GMI) (5.2 vs. 5.6 and 5.65%, p = 0.01) compared to the control and T2DM groups, respectively. The coefficient of variation (CV) significantly increased only in patients with diabetes (17% vs. 26.7%, p < 0.01). Both groups with (0% vs. 2%, p = 0.03) and without (3% vs. 22%, p = 0.03) T2DM experienced an increased time below range with low glucose (54-69 mg/dL). However, patients without T2DM had significantly less time in rage (70-180 mg/dL) (97% vs. 78%, p = 0.04).
Significant differences in CGM metrics among RYGB patients suggest an increase in glycemic variability after surgery, with a longer duration of hypoglycemia, especially in patients without T2DM.
使用连续血糖监测（CGM）评估接受 Roux-en-Y 胃旁路术（RYGB）的 2 型糖尿病（T2DM）和非 2 型糖尿病（T2DM）个体的血糖变异性（GV）。
本前瞻性队列研究比较了 14 例接受 RYGB 的 T2DM 患者（n=7）和非 T2DM 患者（n=7）的 CGM 数据。6 个月后，这些患者与非手术对照组（n=7）进行比较，非手术对照组按 BMI、性别和年龄与 T2DM 组相匹配。
14 例患者接受 RYGB，平均 BMI 为 46.9±5.3kg/m2，平均年龄为 47.9±8.9 岁；85%为女性。手术后 6 个月，总体重减轻（TWL）为 27.1±6.3%，各组之间无显著差异。无糖尿病患者的平均间质葡萄糖水平（81 与 94 和 98mg/dl，p<0.01）和葡萄糖管理指标（GMI）（5.2 与 5.6 和 5.65%，p=0.01）均低于对照组和 T2DM 组。仅糖尿病患者的变异系数（CV）显著增加（17%与 26.7%，p<0.01）。有（0%与 2%，p=0.03）和无（3%与 22%，p=0.03）T2DM 的两组患者的低血糖（54-69mg/dL）时间均增加。然而，无 T2DM 的患者在血糖范围内（70-180mg/dL）的时间明显减少（97%与 78%，p=0.04）。
RYGB 患者 CGM 指标的显著差异表明手术后血糖变异性增加，低血糖持续时间更长，尤其是在无 T2DM 的患者中。
