Gao Xiang, Wang Tao, Li Jiahao, Li Weizheng, Zhu Liyong, Zhu Shaihong, Song Zhi, Li Pengzhou
Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China.
BMC Surg. 2025 Apr 4;25(1):135. doi: 10.1186/s12893-025-02879-9.
While Roux-en-Y gastric bypass (RYGB) has been extensively studied in patients with type 2 diabetes mellitus (T2DM) and preserved islet function, the significance of insulin resistance in guiding RYGB treatment remains unclear. This study aimed to evaluate the efficacy of RYGB in T2DM patients with a low body mass index (BMI, 27.5-35 kg/m²), insulin resistance, and impaired β-cell function.
A retrospective cohort of 34 T2DM patients with low BMI who underwent RYGB at our institution was analyzed. Insulin resistance was assessed using hyperinsulinemic euglycemic clamp. The indicators related to glucose and lipid metabolism were also assessed and collected at baseline and 12 months postoperatively.
Significant reductions in BMI and HbA1c were observed within 12 months post-surgery (P < 0.05). Fasting plasma glucose decreased from 9.40 ± 3.12 mmol/L to 5.87 ± 2.67 mmol/L (P < 0.05). Complete remission rates were 31.25% for T2DM, 100% for hypertriglyceridemia, and 70% for hypertension. Multivariable logistic analysis identified shorter diabetes duration (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.83-0.95, P = 0.025), higher BMI (OR 1.14, 95% CI 1.06-1.34, P = 0.033), and lower peripheral glucose disposal rate (OR 0.95, 95% CI 0.93-0.97, P = 0.043) as independent predictors of diabetes remission.
Patients with T2DM and low BMI who have insulin resistance may still benefit from RYGB, even if they exhibit impaired β cell function. Shorter duration of diabetes, higher BMI and lower peripheral glucose disposal rate were independent predictors of diabetes remission after RYGB.
虽然Roux-en-Y胃旁路术（RYGB）已在2型糖尿病（T2DM）且胰岛功能保留的患者中得到广泛研究，但胰岛素抵抗在指导RYGB治疗中的意义仍不明确。本研究旨在评估RYGB对低体重指数（BMI，27.5 - 35kg/m²）、胰岛素抵抗且β细胞功能受损的T2DM患者的疗效。
对在我院接受RYGB的34例低BMI的T2DM患者进行回顾性队列分析。采用高胰岛素正常血糖钳夹技术评估胰岛素抵抗。在基线和术后12个月时还评估并收集了与糖脂代谢相关的指标。
术后12个月内观察到BMI和糖化血红蛋白（HbA1c）显著降低（P < 0.05）。空腹血糖从9.40± 3.12mmol/L降至5.87± 2.67mmol/L（P < 0.05）。T2DM的完全缓解率为31.25%，高甘油三酯血症为100%，高血压为70%。多变量逻辑分析确定糖尿病病程较短（比值比[OR] 0.89，95%置信区间[CI] 0.83 - 0.95，P = 0.025）、BMI较高（OR 1.14，95% CI 1.06 - 1.34，P = 0.033）和外周葡萄糖处置率较低（OR 0.95，95% CI 0.93 - 0.97，P = 0.043）是糖尿病缓解的独立预测因素。
即使存在β细胞功能受损，伴有胰岛素抵抗的低BMI的T2DM患者仍可能从RYGB中获益。糖尿病病程较短、BMI较高和外周葡萄糖处置率较低是RYGB术后糖尿病缓解的独立预测因素。
