糖尿病患者减肥手术后20%复发

休斯顿——梅奥医院的Yessica Ramos博士报告称，在接受胃旁路手术治疗后病情得到缓解的2型糖尿病患者中，1/5的患者术后5年内糖尿病复发。

Yessica Ramos博士

这项回顾性单中心研究结果还表明，疾病复发率不受术前体重指数(BMI)和术后体重增加的影响，唯一的危险因素是术前2型糖尿病病程较长。患者术前糖尿病史>5年，疾病复发率提高3.8倍。研究者认为其临床意义在于，“2型糖尿病肥胖患者早期接受手术干预或可延长2型糖尿病缓解持续时间。”                  

研究者报告了2000~2007年在梅奥医院接受Roux-en-Y胃旁路手术(RYGB)的72例2型糖尿病肥胖患者术后5年随访数据。患者术前平均BMI为45 kg/m2，平均年龄49.5岁。66例(92%)患者糖尿病得到缓解(停用所有抗糖尿病药物后HbA1c<6.5%)。在这66例患者中，14例(21%)在随访期间复发(HbA1c≥6.5%，空腹血糖>7 mmol/L或使用抗糖尿病药物)，5例患者术后2年即出现糖尿病复发。

目前糖尿病复发率较高的原因仍不清楚。由于减肥手术往往会改变患者的生活方式，患者失访率较高，因此对减肥手术患者进行回顾性研究非常困难。研究者推测，病程较长患者复发风险较高可能与β细胞功能受损更为严重有关。但确切原因尚需等待诸如克利夫兰医学中心报告(N. Engl. J. Med. 2012;366:1567-76)等前瞻性随机对照试验或大规模多中心减肥手术登记资料分析的进一步结果。

Ramos博士报告无利益冲突。

爱思唯尔  版权所有

By: BRUCE JANCIN, Clinical Endocrinology News Digital Network
 
HOUSTON – One in five patients whose type 2 diabetes went into remission following gastric bypass surgery experienced disease re-emergence within 5 years postoperatively.

The likelihood of diabetes recurrence in this retrospective single-center study wasn’t affected by preoperative body mass index or the amount of weight regained postsurgically.

Indeed, the only significant risk factor for diabetes reemergence was a longer duration of type 2 diabetes preoperatively. Patients with a greater than 5-year preoperative history of the disease were 3.8-fold more likely to experience disease recurrence, according to Dr. Yessica Ramos of the Mayo Clinic Arizona, Scottsdale.

The clinical implication: "Early surgical intervention in the type 2 diabetic obese population may improve the durability of remission of type 2 diabetes," she said.

Dr. Ramos reported on 72 obese patients with type 2 diabetes who underwent Roux-en-Y gastric bypass at the Mayo Clinic Arizona during 2000-2007 for whom 5-year follow-up data were available. The patients’ mean preoperative body mass index was 45 kg/m2, with an average age of 49.5 years.

Sixty-six of the 72 patients (92%) experienced remission of their diabetes as defined by a hemoglobin A1c below 6.5% while off all antidiabetic medications. The other six patients had persistent type 2 diabetes throughout follow-up.

A total of 14 of 66 patients, or 21%, whose type 2 diabetes went into remission subsequently saw their disease return as defined by an HbA1c of 6.5% or more, a fasting blood glucose greater than 7 mmol/L, or use of antidiabetic drugs.

Diabetes returned as early as 2 years post surgery in five patients.

The explanation for the high rate of diabetes reemergence remains unclear. Retrospective studies of bariatric surgery patients are notoriously difficult because the surgery is often life changing and patients are frequently lost to follow-up.

Dr. Ramos’s working hypothesis is that patients with longer duration of type 2 diabetes are at a higher risk of recurrence because they have more compromised beta cell function. But definitive answers must await further reports from prospective randomized trials of surgery vs. medication as a treatment for type 2 diabetes in obese patients, such as the one reported from the Cleveland Clinic (N. Engl. J. Med. 2012;366:1567-76), or analysis of data from the large multicenter bariatric surgery registries.

Dr. Ramos reported having no financial conflicts.