A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass.
A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass.
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DOI：
10.1007/s11695-012-0802-1
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发表时间：
2013-01
期刊：
影响因子：
2.9
通讯作者：
Selby J
中科院分区：
文献类型：
--
作者：
Arterburn DE;Bogart A;Sherwood NE;Sidney S;Coleman KJ;Haneuse S;O'Connor PJ;Theis MK;Campos GM;McCulloch D;Selby J
胃转流术对成人2型糖尿病患者的血糖控制有深远的影响。本研究的目的是检查接受胃旁路手术的患者中糖尿病缓解和复发的长期发生率和临床预测因素。我们对1995年至2008年在美国三个综合医疗保健提供系统接受胃旁路术的未控制或药物控制的2型糖尿病成人进行了回顾性队列研究。根据糖尿病药物使用和血糖控制的临床实验室指标定义缓解和复发事件。我们确定了4，434名患有不受控制或药物控制的2型糖尿病的成年人，他们接受了胃旁路手术。总体而言，68.2%（95% CI：66%，70%）的患者在术后5年内经历了初始糖尿病完全缓解。其中，35.1%（95%CI：32%，38%）在5年内再次发生糖尿病。中位缓解时间为8.3年。完全缓解和复发的重要预测因素是术前血糖控制不佳、胰岛素使用和糖尿病病程较长。术后体重轨迹在永不缓解者、复发者和持久缓解者之间存在显著差异（p=0.03）。胃旁路手术与许多但不是所有严重肥胖糖尿病成人的2型糖尿病持久缓解相关，约三分之一的患者在最初缓解后五年内复发。需要更多的研究来了解糖尿病复发的机制，实现持久缓解的最佳手术时机，以及缓解持续时间与微血管和大血管事件之间的关系。
Gastric bypass has profound effects on glycemic control in adults with type 2 diabetes mellitus. The goal of this study was to examine the long-term rates and clinical predictors of diabetes remission and relapse among patients undergoing gastric bypass. We conducted a retrospective cohort study of adults with uncontrolled or medication-controlled type 2 diabetes who underwent gastric bypass from 1995 to 2008 in three integrated health care delivery systems in the United States. Remission and relapse events were defined by diabetes medication use and clinical laboratory measures of glycemic control. We identified 4,434 adults with uncontrolled or medication-controlled type 2 diabetes who had gastric bypass. Overall, 68.2% (95% CI: 66%, 70%) experienced an initial complete diabetes remission within five years after surgery. Among these, 35.1% (95% CI: 32%, 38%) redeveloped diabetes within five years. The median duration of remission was 8.3 years. Significant predictors of complete remission and relapse were poor preoperative glycemic control, insulin use, and longer diabetes duration. Weight trajectories after surgery were significantly different for never remitters, relapsers, and durable remitters (p=0.03). Gastric bypass surgery is associated with durable remission of type 2 diabetes in many but not all severely obese diabetic adults, and about one-third experience a relapse within five years of initial remission. More research is needed to understand the mechanisms of diabetes relapse, the optimal timing of surgery in effecting a durable remission, and the relationship between remission duration and incident microvascular and macrovascular events.