Clinical Improvement After Duodenojejunal Bypass for Nonobese Type 2 Diabetes Despite Minimal Improvement in Glycemic Homeostasis
Clinical Improvement After Duodenojejunal Bypass for Nonobese Type 2 Diabetes Despite Minimal Improvement in Glycemic Homeostasis
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DOI：
10.1007/s00268-009-9968-7
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发表时间：
2009-05-01
影响因子：
2.6
通讯作者：
Fingerhut, A.
中科院分区：
文献类型：
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作者：
Ferzli, G. S.;Dominique, E.;Fingerhut, A.
2型糖尿病（T2DM）的血糖控制一直是困扰医生的难题。虽然对病态肥胖进行胃旁路手术已被证明可以很好地解决这种疾病，但关于十二指肠空肠旁路治疗改善或解决T2DM和代谢综合征（MS）的有效性的数据，特别是在非肥胖患者中很少。本研究旨在评价腹腔镜十二指肠空肠旁路手术（LDJB）治疗体重指数< 35 kg/m的T2DM患者的临床效果(2)。我们对7名T2DM患者进行了为期12个月的前瞻性研究，这些患者的糖尿病病程、糖尿病治疗类型和血糖控制相似，他们接受LDJB治疗后，葡萄糖稳态和MS的变化。实验室值包括糖化血红蛋白A （HbA1c）、空腹血糖、胆固醇、甘油三酯和c肽，随访12个月。随访1个月血清胃抑制肽和胃饥饿素水平。随访3个月血清胃泌素和胰高血糖素样肽水平。术后12个月，所有受试者均持续感到疲劳、四肢疼痛和/或麻木、多尿和多食症状缓解。1例患者获得临床缓解，其余大多数患者术前糖尿病用药需求下降。受试者表现出HbA1c（从9.4%到8.5%）和空腹血糖水平（从209到154 mg/dl）的总体改善。虽然空腹血糖的变化接近统计学意义，但这些葡萄糖稳态测量并没有达到显著性。1年内胆固醇和甘油三酯略有升高，c肽略有下降。这些变化没有统计学意义。虽然这是一个小系列，但我们的数据显示，在手术后12个月，我们所有的7例患者的临床改善都很明显，但LDJB可能不能有效地诱导某些接受该手术的患者缓解T2DM和MS。这表明，在得出手术可以为曾经仅靠药物治疗的疾病提供临床和生化解决方案之前，应该进行更大规模的患者研究。为了更好地评价，需要更长的随访时间。
Glycemic control of type 2 diabetes mellitus (T2DM) remains a dilemma to physicians. Although gastric bypass surgery undertaken for morbid obesity has been shown to resolve this disease well, data on the effectiveness of duodenojejunal bypass in improving or resolving T2DM and the metabolic syndrome (MS), especially in nonobese patients are scarce. This study was intended to evaluate the clinical effects of laparoscopic duodenojejunal bypass (LDJB) in patients with T2DM and a body mass index of < 35 kg/m(2).We conducted a 12-month prospective study on the changes in glucose homeostasis and the MS in seven T2DM subjects undergoing LDJB with similar DM duration, type of DM treatment, and glycemic control. Laboratory values including glycosylated hemoglobin A (HbA1c), fasting blood glucose, cholesterol, triglyceride, and C-peptide were followed throughout the 12 months. Serum levels of gastric inhibitory peptide and ghrelin were followed for 1 month. Serum levels of gastrin and glucagon-like peptide were followed for 3 months.At 12 months after surgery, all subjects consistently felt relief from fatigue, pain and/or numbness in the extremities, polyuria, and polydypsia. Clinical resolution was obtained for one patient, and the preoperative diabetic medication requirements decreased for most of the other patients. The subjects demonstrated an overall improved HbA1c (from 9.4% to 8.5%) and fasting blood glucose level (from 209 to 154 mg/dl). Although the change in fasting blood glucose approached statistical significance, these measures of glucose homeostasis did not achieve significance. Cholesterol and triglycerides increased slightly, and C-peptide decreased slightly over 1 year. These changes were not statistically significant.Although this is a small series, our data show that at 12 months after surgery, clinical improvement was obvious in all of our seven patients, but LDJB may not be effective at inducing remission of T2DM and the MS in certain patients undergoing this operation. This suggests that larger patient studies should be conducted, before concluding that surgery may offer clinical and biochemical resolution to a disease once treated only medically. Longer follow-up is required for better evaluation.