影响减肥手术后的2型糖尿病缓解率的因素
创作:szx 审核:szx 01月11日
  • 纳入8546名接受了减肥手术治疗的瑞典2型糖尿病患者;
  • 受减肥手术2年及5年后,无需使用降糖药物的患者比例分别为76.6%及69.9%;
  • 无需使用降糖药物的几率在疾病持续时间更长的患者中更低;
  • 受减肥手术2年及5年后,2型糖尿病完全缓解的患者比例分别为58.2%及46.6%;
  • 完全缓解的几率在男性患者及治疗前BMI较高的患者中更高,且与疾病持续时间、胰岛素治疗、年龄、治疗前的Hb1Ac水平呈显著负相关。
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PLoS Medicine上发表的一项队列研究结果,纳入瑞典的近1万名接受减肥手术治疗的2型糖尿病患者进行分析,发现影响患者术后缓解率的因素包括:疾病持续时间、性别、治疗前的糖化血红蛋白水平、治疗前的BMI、胰岛素治疗。
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PLoS Medicine [IF:11.048]

Duration of type 2 diabetes and remission rates after bariatric surgery in Sweden 2007–2015: A registry-based cohort study

2007-2015年间瑞典患者的2型糖尿病持续时间与减肥手术后的缓解率

10.1371/journal.pmed.1002985

2019-11-20, Article

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Background: Although bariatric surgery is an effective treatment for type 2 diabetes (T2D) in patients with morbid obesity, further studies are needed to evaluate factors influencing the chance of achieving diabetes remission. The objective of the present study was to investigate the association between T2D duration and the chance of achieving remission of T2D after bariatric surgery.
Methods and findings: We conducted a nationwide register-based cohort study including all adult patients with T2D and BMI ≥ 35 kg/m2 who received primary bariatric surgery in Sweden between 2007 and 2015 identified through the Scandinavian Obesity Surgery Registry. The main outcome was remission of T2D, defined as being free from diabetes medication or as complete remission (HbA1c < 42 mmol/mol without medication). In all, 8,546 patients with T2D were included. Mean age was 47.8 ± 10.1 years, mean BMI was 42.2 ± 5.8 kg/m2, 5,277 (61.7%) were women, and mean HbA1c was 58.9 ± 17.4 mmol/mol. The proportion of patients free from diabetes medication 2 years after surgery was 76.6% (n = 6,499), and 69.9% at 5 years (n = 3,765). The chance of being free from T2D medication was less in patients with longer preoperative duration of diabetes both at 2 years (odds ratio [OR] 0.80/year, 95% CI 0.79–0.81, p < 0.001) and 5 years after surgery (OR 0.76/year, 95% CI 0.75–0.78, p < 0.001). Complete remission of T2D was achieved in 58.2% (n = 2,090) at 2 years, and 46.6% at 5 years (n = 681). The chance of achieving complete remission correlated negatively with the duration of diabetes (adjusted OR 0.87/year, 95% CI 0.85–0.89, p < 0.001), insulin treatment (adjusted OR 0.25, 95% CI 0.20–0.31, p < 0.001), age (adjusted OR 0.94/year, 95% CI 0.93–0.95, p < 0.001), and HbA1c at baseline (adjusted OR 0.98/mmol/mol, 95% CI 0.97–0.98, p < 0.001), but was greater among males (adjusted OR 1.57, 95% CI 1.29–1.90, p < 0.001) and patients with higher BMI at baseline (adjusted OR 1.07/kg/m2, 95% CI 1.05–1.09, p < 0.001). The main limitations of the study lie in its retrospective nature and the low availability of HbA1c values at long-term follow-up.
Conclusions: In this study, we found that remission of T2D after bariatric surgery was inversely associated with duration of diabetes and was highest among patients with recent onset and those without insulin treatment.

First Authors:
Anders Jans

Correspondence Authors:
Erik Stenberg

All Authors:
Anders Jans,Ingmar Näslund,Johan Ottosson,Eva Szabo,Erik Näslund,Erik Stenberg

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