Diabetes Care:肥胖的T2D患者接受Roux-en-Y胃旁路手术与强化生活方式管理的临床结局!

2018-02-07 xing.T MedSci原创

由此可见,随机分组至RYGB或IMWM三年后,肥胖的2型糖尿病患者体重减轻,HbA1c降低,心血管风险降低,肥胖相关生活质量改善较为显著。

近日,糖尿病领域权威杂志Diabetes Care上发表了一篇研究文章,研究人员旨在比较Roux-en-Y胃旁路术(RYGB)手术与强化降糖治疗和体重管理(IMWM)对肥胖2型糖尿病(T2D)患者临床和患者报告结局的影响。

研究人员前瞻性地将38名肥胖T2D患者(15名男性和23名女性,体重平均值±SD为104±16 kg,BMI为36.3±3.4 kg/m2,年龄为52±6岁,HbA1c为8.5±1.3%[69±14mmol/mol])随机分配至腹腔镜RYGB组(19例)或IMWM组(19例),并对体重、HbA1c、心血管危险因素(UKPDS风险)和自我报告的健康状况(36项简表[SF-36]调查、体重对生活质量的影响[IWQOL]工具和糖尿病问题领域[PAID]问卷)方面的变化进行了评估。

研究随访3年后,与IMWM组相比较,RYGB组受试者体重减轻较大(平均为减少24.9kg,95%可信区间为-29.5至-20.4 vs. -5.2 [-10.3至-0.2]; P<0.001),HbA1c降低(-1.79%[-2.38至-1.20] vs. -0.39%[-1.06至0.28] [-19.6mmol/mol(95%可信区间为-26.0至-13.1) vs. -4.3(-11.6至3.1)]; P<0.001)。与IMWM比较,RYGB组受试者冠心病和脑卒中的心脏代谢风险变化更为明显(P <0.05至P <0.01)。在RYGB之后,IWQOL得到了进一步的改善(P<0.001),这主要是由于身体机能、自尊和工作表现的分量表改善所致。两组的SF-36和PAID评分均有所改善,治疗之间无差异。结构方程模型表明整体生活质量的改善与体重减轻之间的相关性比改善HbA1c之间的相关性更强,表现为IWQOL比SF-36或PAID有更大的改善。

由此可见,随机分组至RYGB或IMWM三年后,肥胖的2型糖尿病患者体重减轻,HbA1c降低,心血管风险降低,肥胖相关生活质量改善较为显著。

原始出处:

Donald C. Simonson,et al. Clinical and Patient-Centered Outcomes in Obese Type 2 Diabetes Patients 3 Years After Randomization to Roux-en-Y Gastric Bypass Surgery Versus Intensive Lifestyle Management: The SLIMM-T2D Study. Diabetes Care 2018. https://doi.org/10.2337/dc17-0487

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  7. 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createdBy=0045169, createdName=木头人513, createdTime=Thu Feb 22 17:31:00 CST 2018, time=2018-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1760522, encodeId=bac51e60522e4, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a1a37427546, createdName=ms5439512287675881, createdTime=Sun Oct 14 14:31:00 CST 2018, time=2018-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1843146, encodeId=676e184314671, content=<a href='/topic/show?id=3d052296e4e' target=_blank style='color:#2F92EE;'>#临床结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, 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content=<a href='/topic/show?id=a4be8319879' target=_blank style='color:#2F92EE;'>#胃旁路手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83198, encryptionId=a4be8319879, topicName=胃旁路手术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c5417414181, createdName=zlawrance, createdTime=Fri Feb 09 01:31:00 CST 2018, time=2018-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=286254, encodeId=ff75286254bc, content=阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/fhZdOu27e88Voqh19n8eF8cLplo8L4nicKtH0WnE3KFELXns5XDu8rsiceK2HHDZc2SEStia5VV3Pia2QLMVqlWbHw/0, createdBy=6e012139475, createdName=神功盖世, createdTime=Thu Feb 08 13:52:36 CST 2018, time=2018-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=285935, encodeId=1cae28593501, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Wed Feb 07 13:04:17 CST 2018, time=2018-02-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=285934, encodeId=65ea28593479, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Wed Feb 07 13:03:58 CST 2018, time=2018-02-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=285915, encodeId=32fa2859157b, content=学习学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzR8ylhYfiaoAUx2BsaYHVia1IKhG3Cg8CT84rBrn6iaVRkyAibJxBcLEXabOQ5p19vWgDe34ib5ErxNgx/0, createdBy=8a701629084, createdName=jihuaijun1112, createdTime=Wed Feb 07 11:08:26 CST 2018, time=2018-02-07, status=1, ipAttribution=)]
    2018-02-08 神功盖世

    0

  8. 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createdName=龙胆草, createdTime=Wed Feb 07 13:03:58 CST 2018, time=2018-02-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=285915, encodeId=32fa2859157b, content=学习学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzR8ylhYfiaoAUx2BsaYHVia1IKhG3Cg8CT84rBrn6iaVRkyAibJxBcLEXabOQ5p19vWgDe34ib5ErxNgx/0, createdBy=8a701629084, createdName=jihuaijun1112, createdTime=Wed Feb 07 11:08:26 CST 2018, time=2018-02-07, status=1, ipAttribution=)]
    2018-02-07 龙胆草

    学习谢谢分享

    0

  9. 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createdName=龙胆草, createdTime=Wed Feb 07 13:03:58 CST 2018, time=2018-02-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=285915, encodeId=32fa2859157b, content=学习学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzR8ylhYfiaoAUx2BsaYHVia1IKhG3Cg8CT84rBrn6iaVRkyAibJxBcLEXabOQ5p19vWgDe34ib5ErxNgx/0, createdBy=8a701629084, createdName=jihuaijun1112, createdTime=Wed Feb 07 11:08:26 CST 2018, time=2018-02-07, status=1, ipAttribution=)]
    2018-02-07 龙胆草

    学习谢谢分享

    0

  10. 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