Long-Term Effects of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Surgery on Type 2 Diabetes Mellitus in Morbidly Obese Subjects
Long-Term Effects of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Surgery on Type 2 Diabetes Mellitus in Morbidly Obese Subjects
复制标题
DOI：
10.1097/sla.0b013e318262ee6b
复制
发表时间：
2012-12-01
影响因子：
9
通讯作者：
Vidal, Josep
中科院分区：
文献类型：
--
作者：
Jimenez, Amanda;Casamitjana, Roser;Vidal, Josep
目的：探讨Roux-en-Y胃旁路术（RYGBP）和袖式胃切除术（SG）后2型糖尿病（T2DM）长期缓解和复发率及预测因素。背景：减肥手术后T2DM改善的持久性尚不清楚。方法：153例T2DM患者（RYGBP: n = 98; SG: n = 55）在35.4 +/- 13.5个月的随访中评估疾病的缓解和复发情况。手术类型、人口统计学、人体测量学和生化参数被确定为T2DM预后的预测因子。胰高血糖素样肽1 （GLP-1）在标准混合液体餐后的反应比较在RYGBP或SG后出现T2DM缓解的患者。结果：75.2%的受试者表现为T2DM缓解持续至少12个月。然而，在12.1%的受试者中，T2DM复发。回归分析显示，T2DM持续时间较长（P = 0.006），手术前糖化血红蛋白水平较高（P = 0.019），基线时胰岛素治疗（P = 0.001），最后一次随访时体重减轻较低（P < 0.001）是T2DM缺乏缓解的独立预测因素。术前使用胰岛素（P = 0.005）、年龄较大（P = 0.05）和缓解后体重恢复（P = 0.021）预测疾病复发。SG或RYGBP后T2DM的长期缓解与GLP-1对标准混合液体餐的反应相对增加相关。结论：Roux-en-Y胃旁路术和SG与T2DM的缓解率相关。然而，在病情较晚期的患者中，体重减轻或体重恢复不足可能会阻碍这些手术技术对T2DM的益处。
Objective: To identify the rates and the predictors of long-term remission and the recurrence of type 2 diabetes mellitus (T2DM) after Roux-en-Y gastric bypass (RYGBP) or sleeve gastrectomy (SG).Background: The durability of the improvement of T2DM after bariatric surgery is not well characterized.Methods: One hundred fifty-three subjects with T2DM (RYGBP: n = 98; SG: n = 55) were evaluated for remission and recurrence of the disease throughout 35.4 +/- 13.5months' follow-up. The type of surgery, demographic, anthropometric, and biochemical parameters were ascertained as predictors of T2DM outcomes. Glucagon-like peptide 1 (GLP-1) responses after a standard mixed liquid meal were compared between patients presenting with T2DM remission after RYGBP or SG.Results: 75.2% of subjects presented with remission of T2DM lasting at least 12 months. However, in 12.1% of subjects, T2DM recurred. Regression analysis showed a longer duration of T2DM (P = 0.006), a higher presurgical glycated hemoglobin level (P = 0.019), insulin treatment at baseline (P = 0.001), and a lower excess weight loss at last follow-up visit (P < 0.001) as independent predictors for the lack of T2DM remission. Insulin use before surgery (P = 0.005), an older age (P = 0.05), and weight regain after remission (P = 0.021) predicted recurrence of the disease. Long-term remission of T2DM after SG or RYGBP was associated with a comparably enlarged GLP-1 response to a standard mixed liquid meal challenge.Conclusions: Roux-en-Y gastric bypass and SG are associated with comparable remission rates of T2DM. However, insufficient weight loss or weight regain in those with a more advanced disease may hamper the benefits of these surgical techniques on T2DM.