Efficacy of surgery in the management of obesity-related type 2 diabetes mellitus

被引:43
作者
Gan, Susan S. H.
Talbot, Michael L.
Jorgensen, John O.
机构
[1] Birmingham Heartlands Hosp, Hearts Educ Ctr, Dept Gen Surg, Birmingham B9 5SS, W Midlands, England
[2] St George Hosp, Dept Surg, Sydney, NSW, Australia
关键词
bariatric; diabetes mellitus; obesity; surgery; type; 2; diabetes;
D O I
10.1111/j.1445-2197.2007.04290.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: It is estimated that up to 80% of persons with diabetes mellitus type 2 are overweight and in these patients it is recognized that effective weight control can lead to improvement or even resolution of their diabetes (Colagiuri et al.). All currently carried out operations for morbid obesity have been shown to improve diabetes, but there appears to be a variable response to surgery depending on several surgical and patient factors. Methods: In this prospective review, we analysed the change in the diabetic status in 72 patients undergoing three different bariatric procedures in a single institution over 30 months. A review of the published work comparing the efficacy of the various procedures in achieving improvement or resolution of diabetes was also carried out and correlated to our findings. Results: At an average follow up of 13 months, 50% of patients who had placement of laparoscopic adjustable gastric band had an improvement or resolution of their diabetes, compared with 95% of patients who had had laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass. Two of 12 (17%) laparoscopic adjustable gastric band patients had normal blood glucose levels off all diabetic medications compared with 7 of 21 (33%) laparoscopic sleeve gastrectomy and 27 of 39 (69%) Roux-en-Y gastric bypass patients. There was no significant association between the amount of weight lost and the return to euglycaemia. Conclusion: Direct comparison has shown a significant difference in the effects of different forms of bariatric surgery on type 2 diabetes, this is in keeping with evidence that surgery can lead to improvement in diabetes additional to that obtained by weight loss alone.
引用
收藏
页码:958 / 962
页数:5
相关论文
共 33 条
[11]   High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity [J].
DeMaria, EJ ;
Sugerman, HJ ;
Meador, JG ;
Doty, JM ;
Kellum, JM ;
Wolfe, L ;
Szucs, RA ;
Turner, MA .
ANNALS OF SURGERY, 2001, 233 (06) :809-818
[12]   Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity [J].
DeMaria, J ;
Sugerman, HJ ;
Kellum, JM ;
Meador, JG ;
Wolfe, LG .
ANNALS OF SURGERY, 2002, 235 (05) :640-645
[13]   Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding [J].
Dixon, JB ;
O'Brien, PE .
DIABETES CARE, 2002, 25 (02) :358-363
[14]  
FIELDING GA, 2006, INT FEDERATION SURG
[15]   A new paradigm for type 2 diabetes mellitus - Could it be a disease of the foregut? [J].
Hickey, MS ;
Pories, WJ ;
MacDonald, KG ;
Cory, KA ;
Dohm, GL ;
Swanson, MS ;
Israel, RG ;
Barakat, HA ;
Considine, RV ;
Caro, JF ;
Houmard, JA .
ANNALS OF SURGERY, 1998, 227 (05) :637-644
[16]   Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters [J].
le Roux, CW ;
Aylwin, SJB ;
Batterham, RL ;
Borg, CM ;
Coyle, F ;
Prasad, V ;
Shurey, S ;
Ghatei, MA ;
Patel, AG ;
Bloom, SR .
ANNALS OF SURGERY, 2006, 243 (01) :108-114
[17]   Obesity and its surgical management [J].
Livingston, EH .
AMERICAN JOURNAL OF SURGERY, 2002, 184 (02) :103-113
[18]   The Gastric Bypass Operation Reduces the Progression and Mortality of Non-Insulin-Dependent Diabetes Mellitus [J].
MacDonald Jr. K.G. ;
Long S.D. ;
Swanson M.S. ;
Brown B.M. ;
Morris P. ;
Dohm G.L. ;
Pories W.J. .
Journal of Gastrointestinal Surgery, 1997, 1 (3) :213-220
[19]   Biliopancreatic diversion with duodenal switch [J].
Marceau, P ;
Hould, FS ;
Simard, S ;
Lebel, S ;
Bourque, RA ;
Potvin, M ;
Biron, S .
WORLD JOURNAL OF SURGERY, 1998, 22 (09) :947-954
[20]   Long-term results, late complications and quality of life in a series of adjustable gastric banding [J].
Martikainen, T ;
Pirinen, E ;
Alhava, E ;
Poikolainen, E ;
Pääkkönen, M ;
Uusitupa, M ;
Gylling, H .
OBESITY SURGERY, 2004, 14 (05) :648-654