Diabetes remission and reduced cardiovascular risk after gastric bypass in Asian Indians with body mass index <35 kg/m(2).
Diabetes remission and reduced cardiovascular risk after gastric bypass in Asian Indians with body mass index <35 kg/m(2).
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DOI：
10.1016/j.soard.2009.08.009
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发表时间：
2010-07
期刊：
影响因子：
--
通讯作者：
Cummings DE
中科院分区：
文献类型：
--
作者：
Shah SS;Todkar JS;Shah PS;Cummings DE
Roux-en-Y胃旁路手术（RYGB）有益于BMI>35 kg/m2的2型糖尿病（T2 DM）患者，但其在BMI<35 kg/m2的糖尿病患者中的有效性尚不清楚。亚洲印度人在相对较低的体重指数（BMI）水平下患T2 DM和心血管疾病（CVD）的风险较高。我们研究了RYGB在印度T2 DM患者中的安全性和有效性，BMI为22-35 kg/m2。三级医疗中心。连续15例T2 DM和BMI 22-35 kg/m2的患者接受了RYGB。在术前和术后1、3、6和9个月前瞻性收集数据。术前受试者特征为：男女比例为8：7，年龄45.6±12岁（平均值± SD），BMI 28.9±4.0 kg/m2，体重78.7±12.5 kg，腰围100.2±6.8 cm，糖尿病病程8.7±5.3年。基线时，80%的受试者接受胰岛素治疗，其余接受口服降糖药物治疗。术后BMI下降20%，从28.9±4.0降至23.0±3.6（P<0.001）。80%的受试者在术后1个月内停用所有抗糖尿病药物; 3个月及之后，100%的受试者停用血糖正常的糖尿病药物。空腹血糖（FBG）从233±87降至89±12 mg/dL（P<0.001），血红蛋白A1 c（HbA 1c）从10.1±2.0降至6.1±0.6%（P<0.001）。腰围、血脂异常和高血压明显改善。预测的10年心血管疾病风险（使用UKPDS方程计算）显著降低了致命性和非致命性冠心病（CHD）和中风。无死亡、重大手术并发症或体重过度减轻。RYGB在BMI<35 kg/m2的亚洲印度人中安全有效地消除了T2 DM。需要更大规模、更长期的研究来证实这种益处。
Roux-en-Y gastric bypass surgery (RYGB) benefits patients with type 2 diabetes mellitus (T2DM) and BMI>35 kg/m2, but its effectiveness in diabetics with BMI<35 kg/m2 is unclear. Asian Indians suffer high risks of T2DM and cardiovascular disease (CVD) at relatively low body mass index (BMI) levels. We examined the safety and efficacy of RYGB in Indian patients with T2DM and a BMI of 22–35 kg/m2. Tertiary care medical center. Fifteen consecutive patients with T2DM and BMI 22–35 kg/m2 underwent RYGB. Data were prospectively collected before surgery and at 1, 3, 6, and 9 months afterward. Pre-operative subject characteristics were: male to female 8:7, age 45.6±12 years (mean ± SD), BMI 28.9±4.0 kg/m2, body weight 78.7±12.5 kg, waist circumference 100.2±6.8 cm, duration of diabetes 8.7±5.3 years. At baseline, 80% of subjects were on insulin, the rest on oral hypoglycemic medications. BMI decreased post-operatively by 20%, from 28.9±4.0 to 23.0±3.6 (P<0.001). All anti-diabetes medications were discontinued by 1 month post-surgery in 80% of subjects; by 3 months and thereafter, 100% were euglycemic off diabetes medications. Fasting blood glucose (FBG) decreased from 233±87 to 89±12 mg/dL (P<0.001), while hemoglobin A1c (HbA1c) fell from 10.1±2.0 to 6.1±0.6% (P<0.001). Waist circumference, dyslipidemia, and hypertension improved significantly. Predicted 10-year CVD risk (calculated using UKPDS equations) decreased substantially for fatal and non-fatal coronary heart disease (CHD) and strokes. There was no mortality, major surgical morbidity, or excessive weight loss. RYGB safely and effectively eliminated T2DM in Asian Indians with BMI<35 kg/m2. Larger, longer-term studies are needed to confirm this benefit.
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