The Role of β-Cell Function and Insulin Sensitivity in the Remission of Type 2 Diabetes after Gastric Bypass Surgery
The Role of β-Cell Function and Insulin Sensitivity in the Remission of Type 2 Diabetes after Gastric Bypass Surgery
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DOI：
10.1210/jc.2011-0446
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发表时间：
2011-09-01
影响因子：
5.8
通讯作者：
Ferrannini, E.
中科院分区：
文献类型：
--
作者：
Nannipieri, M.;Mari, A.;Ferrannini, E.
背景：减肥手术可以使大部分重度肥胖的 2 型糖尿病 (T2DM) 患者得到缓解。目的：我们的目的是研究手术引起的糖尿病缓解的预测因子和机制。患者和环境：43 名病态肥胖受试者（体重指数 = 45.6 +/- 5.0 kg/m(2)），其中 32 名患有 T2DM，11 名非糖尿病患者[正常糖耐量] (NGT)]，参与临床研究中心。干预：患者接受Roux-en-Y胃绕道手术。主要结果指标：评估糖尿病缓解和β细胞功能。结果：受试者在手术前、手术后45天和手术后1年进行测试。 T2DM 和 NGT 的体重下降相似（1 年时为-39 kg，P < 0.0001）。两组的胰岛素敏感性均随体重指数的变化而改善，但 T2DM 患者的胰岛素敏感性仍低于 NGT（386 +/- 91 vs. 479 +/- 89 ml/min.m(2)，P < 0.01）。根据糖化血红蛋白和口服葡萄糖测试，9 名患者的糖尿病在 45 天时得到缓解，另外 16 名患者在 1 年时糖尿病得到缓解。在 T2DM 中，β 细胞葡萄糖敏感性在手术后早期有所增加，但没有进一步改善，并且在 1 年时仍然异常 [中位数，48（系数区间，53）pmol/min。米（2）。 mM 与中位数，NGT 100（系数区间，68），P < 0.001]。早期缓解者、晚期缓解者和非缓解者的基线 β 细胞葡萄糖敏感性逐渐恶化（中位数，54[系数区间，50] 与中位数，22[系数区间，26] 与中位数，4[系数区间，10] pmol/min . m(2) . mM），并且通过逻辑回归，是失败的唯一预测因子 [底部三分位数的比值比 = 7.9 （95% 置信区间 = 1.2-51.9）； P = 0.03]。结论：在病态肥胖中，Roux-en-Y 胃绕道手术会导致快速而深刻的代谢适应；胰岛素敏感性的提高与体重减轻成正比，β细胞葡萄糖敏感性的提高与体重减轻无关。手术后一年内，糖尿病的缓解取决于β细胞功能障碍的起始程度。 （临床内分泌代谢杂志 96：E1372-E1379，2011）
Context: Bariatric surgery can induce remission in a high proportion of severely obese patients with type 2 diabetes mellitus (T2DM).Objective: Our objective was to investigate predictors and mechanisms of surgery-induced diabetes remission.Patients and Setting: Forty-three morbidly obese subjects (body mass index = 45.6 +/- 5.0 kg/m(2)), 32 with T2DM and 11 nondiabetic [normal glucose tolerance (NGT)], participated at a clinical research center.Intervention: Patients underwent Roux-en-Y gastric bypass.Main Outcome Measures: Diabetes remission and beta-cell function were evaluated.Results: Subjects were tested before and 45 d and 1 yr after surgery. Weight decreased similarly in T2DM and NGT(-39 kg at 1 yr, P < 0.0001). Insulin sensitivity improved in both groups in proportion to the changes in body mass index but remained lower in T2DM than NGT (386 +/- 91 vs. 479 +/- 89 ml/min . m(2), P < 0.01). Based on glycosylated hemoglobin and oral glucose testing, diabetes had remitted in nine patients at 45 d and in an additional 16 at 1 yr. In T2DM, beta-cell glucose sensitivity increased early after surgery but was no further improved and still abnormal at 1 yr [median, 48 (coefficient interval, 53) pmol/min . m(2) . mM vs. median, 100 (coefficient interval, 68) of NGT, P < 0.001]. Baseline beta-cell glucose sensitivity was progressively worse in early remitters, late remitters, and nonremitters (median, 54[coefficient interval, 50] vs. median, 22[coefficient interval, 26] vs. median, 4[coefficient interval, 10] pmol/min . m(2) . mM) and, by logistic regression, was the only predictor of failure [odds ratio for bottom tertile = 7.9 (95% confidence interval = 1.2-51.9); P = 0.03].Conclusions: In morbid obesity, Roux-en-Y gastric bypass causes rapid and profound metabolic adaptations; insulin sensitivity improves in proportion to the weight loss, and beta-cell glucose sensitivity increases independently of weight loss. Over a period of 1 yr after surgery, diabetes remission depends on the starting degree of beta-cell dysfunction. (J Clin Endocrinol Metab 96: E1372-E1379, 2011)