Meira Inês, Menino João, Ferreira Patrícia, Leite Ana Rita, Gonçalves Juliana, Ferreira Helena Urbano, Ribeiro Sara, Moreno Telma, Silva Diana Festas, Pedro Jorge, Varela Ana, Souto Selma, Freitas Paula, da Costa Eduardo Lima, Queirós Joana, Group Crio
Serviço de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal.
Faculdade de Medicina da, Universidade Do Porto, Porto, Portugal.
Obes Surg. 2025 Jan;35(1):161-169. doi: 10.1007/s11695-024-07592-9. Epub 2024 Dec 23.
Treatment of type 2 diabetes (T2DM) in patients with obesity can be challenging. Metabolic and bariatric surgery (MBS) has shown promising results in improving glycemic control and even achieving remission in T2DM patients with obesity. However, the durability of glycemic improvements in T2DM patients following MBS remains insufficiently studied.
Determine the incidence of durable remission and relapse of T2DM rates 10 years after MBS, characterize the glycemic profile after surgery, and identify factors predicting persistent remission of T2DM.
Retrospective observational study of T2DM patients undergoing MBS between 2010 and 2013. Clinical and analytical assessments were performed preoperatively, at 2- and at 10-years postoperatively. Paired t-tests, Wilcoxon-signed-rank and McNemar tests were used to assess the differences in the metabolic status during the follow-up. Logistic regression models were used to identify predictors of T2DM remission.
Ninety-five patients were included (mean age 48.8 ± 9.1 years, mean HbA1c 7.0 ± 1.5%). Ten years after surgery, the rate of complete T2DM remission was 31%, partial remission was 15%, and late recurrence after initial remission was 24%. Patients with lower HbA1c (OR = 0.50; p = 0.05) and taking fewer antidiabetic drugs (OR = 0.31; p = 0.01) preoperatively were more likely to maintain long-term remission. Ten years post-MBS, patients maintained lower fasting plasma glucose (p < 0.001), HbA1c (p < 0.001), number of antidiabetic drugs (p < 0.001), and insulin use (p < 0.001).
MBS can induce a significant improvement and sustainable remission of T2DM. Early intervention, while patients still have a good glycemic control with a lower number of anti-diabetic drugs, is crucial to achieve long-lasting benefits and a potential "surgical cure" for T2DM.
肥胖患者的2型糖尿病（T2DM）治疗颇具挑战性。代谢与减重手术（MBS）在改善血糖控制甚至使肥胖的T2DM患者实现病情缓解方面已显示出有前景的结果。然而，MBS后T2DM患者血糖改善的持久性仍未得到充分研究。
确定MBS术后10年T2DM持久缓解和复发的发生率，描述术后血糖谱特征，并识别预测T2DM持续缓解的因素。
对2010年至2013年间接受MBS的T2DM患者进行回顾性观察研究。术前、术后2年和10年进行临床和分析评估。采用配对t检验、Wilcoxon符号秩检验和McNemar检验评估随访期间代谢状态的差异。使用逻辑回归模型识别T2DM缓解的预测因素。
纳入95例患者（平均年龄48.8±9.1岁，平均糖化血红蛋白7.0±1.5%）。术后10年，T2DM完全缓解率为31%，部分缓解率为15%，初始缓解后的晚期复发率为24%。术前糖化血红蛋白较低（OR=0.50；p=0.05）且服用抗糖尿病药物较少（OR=0.31；p=0.01）的患者更有可能维持长期缓解。MBS术后10年，患者的空腹血糖（p<0.001）、糖化血红蛋白（p<0.001）、抗糖尿病药物数量（p<0.001）和胰岛素使用量（p<0.001）均维持在较低水平。
MBS可显著改善T2DM并使其实现可持续缓解。在患者仍通过较少数量的抗糖尿病药物保持良好血糖控制时进行早期干预，对于实现T2DM的持久获益和潜在的“手术治愈”至关重要。
