Effects of Diet versus Gastric Bypass on Metabolic Function in Diabetes
Effects of Diet versus Gastric Bypass on Metabolic Function in Diabetes
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DOI：
10.1056/nejmoa2003697
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发表时间：
2020-08-20
影响因子：
158.5
通讯作者：
Klein, Samuel
中科院分区：
文献类型：
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作者：
Yoshino, Mihoko;Kayser, Brandon D.;Klein, Samuel
背景一些研究表明，在2型糖尿病患者中，Roux-en-Y胃旁路手术对代谢功能的影响不依赖于体重减轻。方法我们评估了22例肥胖和糖尿病患者在胃旁路(手术组)或单纯饮食(饮食组)相匹配的体重减轻(约18%)前后糖稳态的代谢调节。主要结果是肝脏胰岛素敏感性的变化，通过低速胰岛素输注(3阶段高胰岛素正常血糖胰腺钳的阶段1和阶段2)进行评估。次要结果是肌肉胰岛素敏感性、β细胞功能以及24小时血糖和胰岛素谱的变化。结果体重减少与从基线开始的平均葡萄糖生成抑制增加有关，节食组每公斤脱脂体重每分钟增加7.04毫摩尔(95%可信区间[CI]，4.74至9.33)，手术组每公斤脱脂体重每分钟增加7.02毫摩尔(95%可信区间，3.21至10.84)，以及5.39(95%可信区间，钳夹阶段2，两组每分钟每公斤脱脂质量分别为2.44~8.34和5.37(95%CI，2.41~8.33)µmol/min；两组之间没有显著差异。体重减轻与胰岛素刺激下葡萄糖摄入量增加有关，饮食组每公斤脱脂体重由30.5+/-15.9升至61.6+/-13.0单位摩尔/分钟，手术组由29.4+/-12.6升至54.5+/-10.4单位摩尔/分钟，两组间差异无统计学意义。减肥使胰岛β细胞功能(胰岛素分泌相对于胰岛素敏感性)在节食组增加1.83个单位(95%CI，1.22~2.44)，在手术组增加1.11个单位(95%CI，0.08~2.15)，两组之间没有显著差异，而且两组24小时血糖和胰岛素水平的曲线下面积减少，两组之间没有显著差异。结论在这项涉及肥胖和2型糖尿病患者的研究中，胃旁路手术和饮食的代谢益处相似，显然与减肥本身有关，没有明显的临床重要影响，独立于体重减轻。
BACKGROUNDSome studies have suggested that in people with type 2 diabetes, Roux-en-Y gastric bypass has therapeutic effects on metabolic function that are independent of weight loss.METHODSWe evaluated metabolic regulators of glucose homeostasis before and after matched (approximately 18%) weight loss induced by gastric bypass (surgery group) or diet alone (diet group) in 22 patients with obesity and diabetes. The primary outcome was the change in hepatic insulin sensitivity, assessed by infusion of insulin at low rates (stages 1 and 2 of a 3-stage hyperinsulinemic euglycemic pancreatic clamp). Secondary outcomes were changes in muscle insulin sensitivity, beta-cell function, and 24-hour plasma glucose and insulin profiles.RESULTSWeight loss was associated with increases in mean suppression of glucose production from baseline, by 7.04 mu mol per kilogram of fat-free mass per minute (95% confidence interval [CI], 4.74 to 9.33) in the diet group and by 7.02 mu mol per kilogram of fat-free mass per minute (95% CI, 3.21 to 10.84) in the surgery group during clamp stage 1, and by 5.39 (95% CI, 2.44 to 8.34) and 5.37 (95% CI, 2.41 to 8.33) mu mol per kilogram of fat-free mass per minute in the two groups, respectively, during clamp stage 2; there were no significant differences between the groups. Weight loss was associated with increased insulin-stimulated glucose disposal, from 30.5 +/- 15.9 to 61.6 +/- 13.0 mu mol per kilogram of fat-free mass per minute in the diet group and from 29.4 +/- 12.6 to 54.5 +/- 10.4 mu mol per kilogram of fat-free mass per minute in the surgery group; there was no significant difference between the groups. Weight loss increased beta-cell function (insulin secretion relative to insulin sensitivity) by 1.83 units (95% CI, 1.22 to 2.44) in the diet group and by 1.11 units (95% CI, 0.08 to 2.15) in the surgery group, with no significant difference between the groups, and it decreased the areas under the curve for 24-hour plasma glucose and insulin levels in both groups, with no significant difference between the groups. No major complications occurred in either group.CONCLUSIONSIn this study involving patients with obesity and type 2 diabetes, the metabolic benefits of gastric bypass surgery and diet were similar and were apparently related to weight loss itself, with no evident clinically important effects independent of weight loss.