Impact of bariatric surgery on the development of diabetic microvascular and macrovascular complications
Impact of bariatric surgery on the development of diabetic microvascular and macrovascular complications
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DOI：
10.1007/s00464-020-07848-2
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发表时间：
2020-08-03
影响因子：
3.1
通讯作者：
Spaniolas, Konstantinos
中科院分区：
文献类型：
--
作者：
Goldberg, Iliya;Nie, Lizhou;Spaniolas, Konstantinos
背景：虽然减肥手术已被证明能改善肥胖人群中2型糖尿病(DM)的控制，但其对长期DM并发症的影响还没有得到彻底的研究。本研究的目的是评估接受减肥手术的肥胖糖尿病患者的微血管和大血管并发症的发展情况。方法利用2006-2012年SPARCS数据库中纽约患者的记录来识别肥胖的糖尿病患者。将接受减肥手术的患者与年龄和性别匹配的内科管理的患者进行比较。根据受控或未受控糖尿病患者的基线情况对患者进行分组，并随着时间的推移对微血管和大血管并发症的发展进行随访。将死亡视为相互竞争的风险事件，估计并发症的累积发生率。在调整可能的混杂因素后，使用多变量比例次分布风险模型来比较不同患者组之间的并发症风险。结果共回顾88,981例患者，其中15,585例(18%)接受了减肥手术。手术患者发生微血管并发症的风险明显低于非手术患者(控制性糖尿病：HR=0.40，95%CI为0.37~0.42；未控制性糖尿病：HR=0.51，95%CI为0.37~0.71)。同样，与非手术患者相比，手术患者发生大血管并发症的风险显著降低(控制性糖尿病：HR=0.43，95%CI为0.40~0.46；未控制性糖尿病：HR=0.44，95%CI为0.28~0.69)。糖尿病控制组和未控制组1、5、9年微血管并发症的累积发生率较低。大血管并发症也有类似的趋势。结论减肥手术可预防糖尿病并发症的发生。与非手术对照组相比，接受减肥手术的糖尿病患者微血管和大血管并发症的发生率显著降低。减肥手术被认为对复杂和非复杂的糖尿病患者都有保护作用。从长远来看，并发症发生率的下降是持续的。
Background While bariatric surgery has been shown to improve type 2 diabetes (DM) control in the obese population, the effect on long-term DM complications has been less thoroughly investigated. The purpose of this study was to assess the development of microvascular and macrovascular complications in obese DM patients undergoing bariatric surgery. Methods New York patients' records from the SPARCS database in years 2006-2012 were used to identify obese patients with DM. Patients undergoing bariatric surgery were compared with patients managed medically, matched for age and gender. Patients were grouped based on baseline presence of controlled or uncontrolled DM and followed over time for the development of micro- and macrovascular complications. Cumulative incidence of complications was estimated with death treated as a competing risk event. Multivariable proportional sub-distribution hazards models were used to compare the risk of complications among different patient groups after adjusting for possible confounding factors. Results A total of 88,981 patients were reviewed, including 15,585 (18%) that were treated with bariatric surgery. Surgery patients had significantly lower risk of microvascular complications compared to non-surgery patients (controlled diabetes: HR = 0.40, 95% CI 0.37-0.42; uncontrolled diabetes: HR = 0.51, 95% CI 0.37-0.71). Similarly, the surgical patients were noted to have a significantly lower risk for macrovascular complications compared to non-surgery patients (controlled diabetes: HR = 0.43, 95% CI 0.40-0.46; uncontrolled diabetes: HR = 0.44, 95% CI 0.28-0.69). Cumulative incidence of microvascular complications was lower at 1, 5 and 9 years for the surgical groups for controlled and uncontrolled DM. Similar trends were observed for the macrovascular complications. Conclusions Bariatric surgery appears to prevent complications of DM. Bariatric surgery patients with DM experienced significantly lower rates of microvascular and macrovascular complications, compared to non-surgically treated comparison group. Bariatric surgery was noted to offer protective benefits for both complicated and non-complicated DM patients. This reduced rate of complications was sustained in the long term.