Can a Protocol for Glycaemic Control Improve Type 2 Diabetes Outcomes After Gastric Bypass?
Can a Protocol for Glycaemic Control Improve Type 2 Diabetes Outcomes After Gastric Bypass?
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血糖控制方案能否改善胃绕道手术后 2 型糖尿病的预后？
DOI：
10.1007/s11695-011-0543-6
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发表时间：
2012
期刊：
影响因子：
2.9
通讯作者：
Carel W. le Roux
中科院分区：
文献类型：
--
作者：
Wiebke K. Fenske;Dimitri J. Pournaras;Erlend T. Aasheim;Alexander D. Miras;Nicola Scopinaro;Samantha Scholtz;Carel W. le Roux
研究背景Roux-en-Y胃旁路手术（RYGB）是治疗2型糖尿病（T2 DM）的有效方法。RYGB治疗T2 DM后立即严格控制血糖可能改善长期血糖结局，但也与低血糖风险较高相关。我们设计了一种治疗算法，以达到最佳的血糖控制胰岛素治疗的T2 DM患者RYGB后，并评估其可行性，安全性和effictiveness.MethodsFifty患者以下协议驱动的糖尿病管理出院的固定量的二甲双胍和甘精胰岛素，调整胰岛素剂量根据标准化的胰岛素滑动量表，旨在空腹毛细血管血糖（FCG）为5.5-6.9 mmol/L。糖尿病的血糖结局和缓解（定义为HbA 1c < 6%和FCG水平< 5.6 mmol/L，至少1年未使用降血糖药物）在接受方案驱动治疗的患者与接受标准血糖管理的49例患者的类似队列之间进行比较。方案驱动组在血糖控制方面比非方案驱动组有更大的改善（HbA 1c −3.0 ± 0. 2% vs. −1.2 ± 0.1%，P < 0.001; FCG水平−3.4 ± 0.2 vs. −2.0 ± 0.2 mmol/L，P= 0.02），T2 DM的缓解率更高（50. 0% vs. 6.1%，P < 0.001）。没有症状性低血糖的报道，在任何group.ConclusionsThe协议驱动的管理被证明是可行的，安全和有效的，在RYGB后实现有针对性的血糖控制T2 DM。下一步将是在随机对照临床试验中仔细检查方案驱动管理的有效性。
BackgroundRoux-en-Y gastric bypass surgery (RYGB) is an effective treatment for patients with type 2 diabetes (T2DM). Tight glycaemic control immediately after RYGB for T2DM may improve long-term glycaemic outcomes, but is also associated with a higher risk of hypoglycaemia. We designed a treatment algorithm to achieve optimal glycaemic control in patients with insulin-treated T2DM after RYGB and evaluated its feasibility, safety and efficacy.MethodsFifty patients following protocol-driven diabetes management were discharged on a fixed amount of metformin and glargine, with the insulin dose adjusted according to a standardised insulin sliding scale aiming for a fasting capillary glucose (FCG) of 5.5–6.9 mmol/L. Glycaemic outcome and remission of diabetes (defined as HbA1c < 6% and FCG levels < 5.6 mmol/L for at least 1 year without hypoglycaemic medication) were compared between patients who received protocol-driven treatment and a similar cohort of 49 patients following standard glycaemic management.ResultsAt 1 year follow-up, the protocol-driven group showed a greater improvement in glycaemic control than the non-protocol-driven group (HbA1c −3.0 ± 0.2% vs. −1.2 ± 0.1%,P< 0.001; FCG levels −3.4 ± 0.2 vs. −2.0 ± 0.2 mmol/L,P= 0.02) and a higher remission rate from T2DM (50.0% vs. 6.1%,P< 0.001). No symptomatic hypoglycaemia was reported in either group.ConclusionsThe protocol-driven management proved to be feasible, safe and effective in achieving targeted glycaemic control in T2DM after RYGB. The next step will be to scrutinise the efficacy of protocol-driven management in a randomised controlled clinical trial.
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影响因子：
6.1
作者：
Nasr, CE;Hoogwerf, BJ;Reddy, SSK
通讯作者：
Reddy, SSK
糖尿病的医疗标准 - 2010年。
影响因子：
16.2
作者：
American Diabetes Association
通讯作者：
American Diabetes Association
2 型糖尿病和心血管风险的管理
影响因子：
11.5
作者：
H. Yki
通讯作者：
H. Yki
影响因子：
158.5
作者：
Duckworth, William;Abraira, Carlos;Huang, Grant D.
通讯作者：
Huang, Grant D.
影响因子：
158.5
作者：
Gerstein, Hertzel C.;Miller, Michael E.;Friedewald, William T.
通讯作者：
Friedewald, William T.