Rapid improvement in diabetes after gastric bypass surgery: is it the diet or surgery?
Rapid improvement in diabetes after gastric bypass surgery: is it the diet or surgery?
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DOI：
10.2337/dc12-2316
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发表时间：
2013-09
期刊：
影响因子：
16.2
通讯作者：
Livingston E
中科院分区：
文献类型：
--
作者：
Lingvay I;Guth E;Islam A;Livingston E
Roux-en-Y胃旁路手术（RYGB）后糖尿病的改善通常发生在手术后几天。手术引起的激素变化和术后限制性饮食是提出的机制。我们评估了热量限制与手术诱导的术后血糖稳态改变的作用。计划接受RYGB治疗的2型糖尿病患者参加了一项前瞻性两期研究（每期住院10天，间隔至少6周的洗脱期），其中患者作为自己的对照组。手术期仅包括饮食。术后各方面进行匹配（日常饮食匹配），包括RYGB手术。在整个研究过程中，每4小时进行一次葡萄糖测量。每期前后分别进行混合饲粮激发试验。10例患者完成了研究，具有以下特征：年龄，53.2岁（95% CI, 48.0-58.4）；BMI为51.2 kg/m2 (46.1-56.4)；糖尿病病程：7.4年（4.8-10.0年）；HbA1c为8.52%（7.08-9.96）。患者术前体重减轻7.3 kg(8.1-6.5)，术后体重减轻4.0 kg(6.2-1.7)（两期间P = 0.01）。术前日血糖较术后显著降低（1,293.58 mg/dL·d [1,096.83-1,490.33] vs. 1,478.80 mg/dL·d[1,277.47-1,680.13]）（两期间P = 0.02）。两期空腹和刺激后最大血糖和6小时血糖曲线下面积（主要结局）的改善相似。葡萄糖稳态在低热量饮食后得到改善，与RYGB后相比，在没有手术的情况下观察到更大的效果。这些发现表明，减少卡路里摄入可以解释RYGB后观察到的糖尿病控制的显著改善。
Improvements in diabetes after Roux-en-Y gastric bypass (RYGB) often occur days after surgery. Surgically induced hormonal changes and the restrictive postoperative diet are proposed mechanisms. We evaluated the contribution of caloric restriction versus surgically induced changes to glucose homeostasis in the immediate postoperative period. Patients with type 2 diabetes planning to undergo RYGB participated in a prospective two-period study (each period involved a 10-day inpatient stay, and periods were separated by a minimum of 6 weeks of wash-out) in which patients served as their own controls. The presurgery period consisted of diet alone. The postsurgery period was matched in all aspects (daily matched diet) and included RYGB surgery. Glucose measurements were performed every 4 h throughout the study. A mixed-meal challenge test was performed before and after each period. Ten patients completed the study and had the following characteristics: age, 53.2 years (95% CI, 48.0–58.4); BMI, 51.2 kg/m2 (46.1–56.4); diabetes duration, 7.4 years (4.8–10.0); and HbA1c, 8.52% (7.08–9.96). Patients lost 7.3 kg (8.1–6.5) during the presurgery period versus 4.0 kg (6.2–1.7) during the postsurgery period (P = 0.01 between periods). Daily glycemia in the presurgery period was significantly lower (1,293.58 mg/dL·day [1,096.83–1,490.33) vs. 1,478.80 mg/dL·day [1,277.47–1,680.13]) compared with the postsurgery period (P = 0.02 between periods). The improvements in the fasting and maximum poststimulation glucose and 6-h glucose area under the curve (primary outcome) were similar during both periods. Glucose homeostasis improved in response to a reduced caloric diet, with a greater effect observed in the absence of surgery as compared with after RYGB. These findings suggest that reduced calorie ingestion can explain the marked improvement in diabetes control observed after RYGB.
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仅在发生大量体重减轻并与减肥幅度相关后，才能观察到胃旁路手术后的外周葡萄糖吸收的改善。
影响因子：
3.2
作者：
Campos, Guilherme M.;Rabl, Charlotte;Peeva, Sofia;Ciovica, Ruxandra;Rao, Madhu;Schwarz, Jean-Marc;Havel, Peter;Schambelan, Morris;Mulligan, Kathleen
通讯作者：
Mulligan, Kathleen
影响因子：
2.9
作者：
Arterburn DE;Bogart A;Sherwood NE;Sidney S;Coleman KJ;Haneuse S;O'Connor PJ;Theis MK;Campos GM;McCulloch D;Selby J
通讯作者：
Selby J
影响因子：
29.4
作者：
Bradley D;Magkos F;Klein S
通讯作者：
Klein S
影响因子：
5.8
作者：
Laferrere, Blandine;Teixeira, Julio;Olivan, Blanca
通讯作者：
Olivan, Blanca
影响因子：
2.9
作者：
Wickremesekera, K;Miller, G;Stubbs, RS
通讯作者：
Stubbs, RS