Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up
Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up
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DOI：
10.1016/j.soard.2009.09.019
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发表时间：
2010-05-01
影响因子：
3.1
通讯作者：
Bessler, Marc
中科院分区：
文献类型：
--
作者：
DiGiorgi, Mary;Rosen, Daniel J.;Bessler, Marc
背景：研究表明，2型糖尿病（T2 DM）在Roux-en-Y胃旁路术（RYGB）后很快改善或消退。关于T2 DM复发或体重恢复对T2 DM状态的影响的数据很少：对42例RYGB T2 DM患者进行了回顾，并进行了≥ 3年的随访和实验室数据。评估术后体重减轻和T2 DM状态。复发或恶化定义为血红蛋白Ale >6.0%和空腹血糖>124 mg/dL和/或缓解或改善后需要药物治疗。结果：T2 DM患者中，T2 DM缓解或改善者分别占64%和36%，复发或恶化者占24%（10例）。复发或恶化的患者术前体重指数低于无复发或恶化的患者（47.9与52.9 kg/m2; P = 0.05），体重减轻的比例恢复得更大（37.7%对15.4%; P = 0.002），体重减轻失败率更高（63%对14%; P = 0.03），术后血糖水平更高（138对102 mg/dL; P = 0.0002）。在RYGB前需要胰岛素或口服药物的患者更有可能出现改善而不是消退（92% vs 8%，P
Background: Studies have shown that type 2 diabetes (T2DM) improves or resolves shortly after Roux-en-Y gastric bypass (RYGB). Few data are available on T2DM recurrence or the effect of weight regain on T2DM status.Methods: A review of 42 RYGB patients with T2DM and >= 3 years of follow-up and laboratory data was performed. Postoperative weight loss and T2DM status was assessed. Recurrence or worsening was defined as hemoglobin Ale >6.0% and fasting glucose >124 mg/dL and/or medication required after remission or improvement. Patients whose T2DM recurred or worsened were compared with those whose did not, and patients whose T2DM improved were compared with those whose T2DM resolved.Results: T2DM had either resolved or improved in all patients (64% and 36%, respectively); 24% (10) recurred or worsened. The patients with recurrence or worsening had had a lower preoperative body mass index than those without recurrence or worsening (47.9 versus 52.9 kg/m2; P = .05), regained a greater percentage of their lost weight (37.7% versus 15.4%; P = .002), had a greater weight loss failure rate (63% versus 14%; P = .03), and had greater postoperative glucose levels (138 versus 102 mg/dL; P = .0002). Patients who required insulin or oral medication before RYGB were more likely to experience improvement rather than resolution (92% versus 8%, P