详细记录  
题名:Effects of Roux-en-Y gastric bypass or diabetes support and education on insulin sensitivity and insulin secretion in morbidly obese patients with type 2 diabetes.
作者:KHOO CM; CHEN J; PAMUKLAR Z; TORQUATI A;
来源:Ann Surg. 2014 Mar;259(3):494-501. doi: 10.1097/SLA.0b013e318294d19c. [ IF= 0.00 ] ]
URL :10.1097/SLA.0b013e318294d19c
日期:20140408
摘要:OBJECTIVE: The long-term changes in insulin sensitivity and beta-cell function in
morbidly obese patients with type 2 diabetes mellitus who undergo Roux-en-Y
gastric bypass (RYGB) surgery or standard medical care remain unclear. We
prospectively studied longitudinal changes of glucostatic parameters in morbidly
obese patients with type 2 diabetes mellitus undergoing RYGB surgery or diabetes
support and education (DSE). RESEARCH METHODS AND DESIGN: Sixty-one morbidly
obese subjects (41.7 +/- 0.6 kg/m) with type 2 diabetes mellitus were assigned to
RYGB surgery (n = 30) or DSE (n = 31). They were matched for sex, age, and body
weight. Insulin sensitivity index (Si) and acute insulin response (AIR) were
derived from frequently sampled intravenous glucose tolerance test. Body
composition was measured using dual-energy x-ray absorptiometry. General linear
model with repeated measures was used to examine the longitudinal changes
(baseline, 6 months, 12 months) in these parameters. RESULTS: At 12-month
follow-up, significant improvement in obesity measures, body composition, glucose
homeostasis, Si, and AIR was observed after RYGB surgery and weight loss. These
outcomes were not influenced by preoperative insulin use. Although there were no
significant changes in the body composition among DSE subjects, they experienced
a decline in the Si and AIR, along with an increase in fasting glucose and HbA1c.
The between-group differences in Si and AIR at 12-month follow-up were completely
attenuated with adjustment to changes in body weight. CONCLUSIONS: The long-term
effects of RYGB surgery on glucostatic parameters are partly dependent on weight
loss. In morbidly obese patients with diabetes who were offered DSE, a
progressive decline in the glucose homeostasis and glucostatic parameters is
observed despite absence of weight gain. (NCT00787670).

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