Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes: analysis of a randomized control trial comparing surgery with intensive medical treatment.
Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes: analysis of a randomized control trial comparing surgery with intensive medical treatment.
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DOI：
10.2337/dc12-1596
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发表时间：
2013-08
期刊：
影响因子：
16.2
通讯作者：
Schauer PR
中科院分区：
文献类型：
--
作者：
Kashyap SR;Bhatt DL;Wolski K;Watanabe RM;Abdul-Ghani M;Abood B;Pothier CE;Brethauer S;Nissen S;Gupta M;Kirwan JP;Schauer PR
目的：比较两种减肥方法与强化药物治疗对β细胞功能和体成分的影响。这是一项前瞻性、随机、对照试验，研究对象为60例未控制的2型糖尿病患者(糖化血红蛋白9.7±1%)和中度肥胖(BMI 36±2 kg/m2)，随机分为单纯IMT组、IMT+Roux-en-Y胃分流术组、IMT+袖状胃切除术组。在基线、12个月和24个月时进行β细胞功能(混合膳食耐量试验)和身体成分的评估。24个月后，三组患者的血糖控制均有改善(N=54)，胃旁路组、袖状胃切除组和IMT组的HbA1c分别为6.7±1.2%、7.1±0.8%和8.4±2.3%(P<；0.05)。两个手术组的体脂减少情况相似，胃旁路术中躯干脂肪的绝对减少量比袖状胃切除术大(−16vs.−10%；P=0.04)。在胃旁路手术中，胰岛素敏感性较术前显著增加(P=0.004)，而在袖状胃切除术或颈动脉内膜成形术中胰岛素敏感性无明显变化。β细胞功能(口腔倾向性指数)在胃旁路手术中较术前提高了5.8倍，显著高于内膜移植(P=0.001.0 5)，而袖状胃切除组与内膜移植组无显著差异(P=0.30)。在24个月时，β细胞功能与躯干脂肪和膳食游离脂肪酸水平呈负相关。与2年的强化药物治疗相比，减肥手术提供了持久的血糖控制。尽管体重减轻与袖状胃切除术相似，但胃旁路手术独特地恢复了胰腺β细胞功能，减少了躯干脂肪，从而扭转了糖尿病的核心缺陷。
To evaluate the effects of two bariatric procedures versus intensive medical therapy (IMT) on β-cell function and body composition. This was a prospective, randomized, controlled trial of 60 subjects with uncontrolled type 2 diabetes (HbA1c 9.7 ± 1%) and moderate obesity (BMI 36 ± 2 kg/m2) randomized to IMT alone, IMT plus Roux-en-Y gastric bypass, or IMT plus sleeve gastrectomy. Assessment of β-cell function (mixed-meal tolerance testing) and body composition was performed at baseline and 12 and 24 months. Glycemic control improved in all three groups at 24 months (N = 54), with a mean HbA1c of 6.7 ± 1.2% for gastric bypass, 7.1 ± 0.8% for sleeve gastrectomy, and 8.4 ± 2.3% for IMT (P < 0.05 for each surgical group versus IMT). Reduction in body fat was similar for both surgery groups, with greater absolute reduction in truncal fat in gastric bypass versus sleeve gastrectomy (−16 vs. −10%; P = 0.04). Insulin sensitivity increased significantly from baseline in gastric bypass (2.7-fold; P = 0.004) and did not change in sleeve gastrectomy or IMT. β-Cell function (oral disposition index) increased 5.8-fold in gastric bypass from baseline, was markedly greater than IMT (P = 0.001), and was not different between sleeve gastrectomy versus IMT (P = 0.30). At 24 months, β-cell function inversely correlated with truncal fat and prandial free fatty acid levels. Bariatric surgery provides durable glycemic control compared with intensive medical therapy at 2 years. Despite similar weight loss as sleeve gastrectomy, gastric bypass uniquely restores pancreatic β-cell function and reduces truncal fat, thus reversing the core defects in diabetes.
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影响因子：
5.8
作者：
Kashyap, Sangeeta R.;Bhatt, Deepak L.;Schauer, Philip R.
通讯作者：
Schauer, Philip R.
影响因子：
5.8
作者：
Laferrere, Blandine;Teixeira, Julio;Olivan, Blanca
通讯作者：
Olivan, Blanca
影响因子：
16.2
作者：
Laferrere, Blandine;Heshka, Stanley;Olivan, Blanca
通讯作者：
Olivan, Blanca
影响因子：
15.9
作者：
NAUCK, MA;HEIMESAAT, MM;CREUTZFELDT, W
通讯作者：
CREUTZFELDT, W
DOI：
10.1152/ajpendo.1999.277.2.e283
发表时间：
1999-08-01
影响因子：
5.1
作者：
Shah, P;Basu, A;Rizza, R
通讯作者：
Rizza, R