Reversal of Type 2 Diabetes Mellitus and Improvements in Cardiovascular Risk Factors After Surgical Weight Loss in Adolescents
Reversal of Type 2 Diabetes Mellitus and Improvements in Cardiovascular Risk Factors After Surgical Weight Loss in Adolescents
复制标题
DOI：
10.1542/peds.2008-0522
复制
发表时间：
2009-01-01
期刊：
影响因子：
8
通讯作者：
Dolan, Lawrence M.
中科院分区：
文献类型：
--
作者：
Inge, Thomas H.;Miyano, Go;Dolan, Lawrence M.
目标。2型糖尿病与肥胖、血脂异常和高血压有关，这些都是众所周知的心血管疾病的危险因素。通过手术减肥，这些危险因素在成人中显著降低。我们假设胃旁路手术可以改善青少年2型糖尿病患者的代谢功能障碍和心血管风险。11名青少年在5个中心接受Roux-en-Y胃搭桥术。分析人体测量、血流动力学和生化指标以及手术并发症。结果：接受Roux-en-Y胃旁路手术的青少年非常肥胖(平均BMI为50+/-5.9 kg/m(2))，并伴有多种心血管危险因素。手术后，除1名患者外，所有患者都有2型糖尿病缓解的证据。体重指数(-34%)、空腹血糖(-41%)、空腹胰岛素浓度(-81%)、血红蛋白A1c水平(7.3%-5.6%)和胰岛素敏感性也有显著改善。血脂水平和血压均有显著改善。相比之下，在治疗1年期间接受跟踪治疗的2型糖尿病青少年体重稳定(基线BMI：35+/-7.3 kg/m(2)；1年BMI：34.9+/-7.2 kg/m(2))，血压或糖尿病药物使用没有显著变化。接受药物治疗的患者在一年内显著改善了血红蛋白A1c水平(基线：7.85%+/-2.3%；一年：7.1%+/-2%)。结论：极度肥胖的糖尿病青少年在Roux-en-Y胃分流术后体重显著减轻，2型糖尿病得到缓解。胰岛素抵抗、β细胞功能和心血管危险因素的改善支持Roux-en-Y胃搭桥术作为一种改善这些青少年健康的干预措施。虽然Roux-en-Y胃分流术的长期疗效尚不清楚，但这些发现表明Roux-en-Y胃分流术是治疗患有2型糖尿病的极端肥胖青少年的有效选择。儿科2009；123：214-222
OBJECTIVES. Type 2 diabetes mellitus is associated with obesity, dyslipidemia, and hypertension, all well-known risk factors for cardiovascular disease. Surgical weight loss has resulted in a marked reduction of these risk factors in adults. We hypothesized that gastric bypass would improve parameters of metabolic dysfunction and cardiovascular risk in adolescents with type 2 diabetes mellitus.PATIENTS AND METHODS. Eleven adolescents who underwent Roux-en-Y gastric bypass at 5 centers were included. Anthropometric, hemodynamic, and biochemical measures and surgical complications were analyzed. Similar measures from 67 adolescents with type 2 diabetes mellitus who were treated medically for 1 year were also analyzed.RESULTS. Adolescents who underwent Roux-en-Y gastric bypass were extremely obese (mean BMI of 50 +/- 5.9 kg/m(2)) with numerous cardiovascular risk factors. After surgery there was evidence of remission of type 2 diabetes mellitus in all but 1 patient. Significant improvements in BMI (-34%), fasting blood glucose (-41%), fasting insulin concentrations (-81%), hemoglobin A1c levels (7.3%-5.6%), and insulin sensitivity were also seen. There were significant improvements in serum lipid levels and blood pressure. In comparison, adolescents with type 2 diabetes mellitus who were followed during 1 year of medical treatment demonstrated stable body weight (baseline BMI: 35 +/- 7.3 kg/m(2); 1-year BMI: 34.9 +/- 7.2 kg/m(2)) and no significant change in blood pressure or in diabetic medication use. Medically managed patients had significantly improved hemoglobin A1c levels over 1 year (baseline: 7.85% +/- 2.3%; 1 year: 7.1% +/- 2%).CONCLUSIONS. Extremely obese diabetic adolescents experience significant weight loss and remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass. Improvements in insulin resistance, beta-cell function, and cardiovascular risk factors support Roux-en-Y gastric bypass as an intervention that improves the health of these adolescents. Although the long-term efficacy of Roux-en-Y gastric bypass is not known, these findings suggest that Roux-en-Y gastric bypass is an effective option for the treatment of extremely obese adolescents with type 2 diabetes mellitus. Pediatrics 2009;123:214-222