Factors associated with relapse of type 2 diabetes mellitus after laparoscopic sleeve gastrectomy in Japanese subjects: a subgroup analysis of J-SMART study

被引：5

作者：

Watanabe, Yasuhiro ^{[1
]}

Yamaguchi, Takashi ^{[1
]}

Nagayama, Daiji ^{[1
,2
]}

Tanaka, Sho ^{[1
]}

Sasaki, Akira ^{[3
]}

Naitoh, Takeshi ^{[4
]}

Matsubara, Hisahiro ^{[5
]}

Yokote, Koutaro ^{[6
]}

Okazumi, Shinichi ^{[7
]}

Ugi, Satoshi ^{[8
]}

Yamamoto, Hiroshi ^{[9
]}

Ohta, Masayuki ^{[10
]}

Ishigaki, Yasushi ^{[11
]}

Kasama, Kazunori ^{[12
]}

Seki, Yosuke ^{[12
]}

Tsujino, Motoyoshi ^{[13
]}

Shirai, Kohji ^{[14
]}

Miyazaki, Yasuhiro ^{[15
]}

Masaki, Takayuki ^{[16
]}

Saiki, Atsuhito ^{[1
]}

Tatsuno, Ichiro ^{[1
,17
]}

机构：

[1] Toho Univ, Ctr Diabet Endocrinol & Metab, Sakura Med Ctr, Chiba, Japan

[2] Nagayama Clin, Tochigi, Japan

[3] Iwate Med Univ, Dept Surg, Sch Med, Morioka, Iwate, Japan

[4] Kitasato Univ, Dept Lower Gastrointestinal Surg, Sch Med, Sagamihara, Kanagawa, Japan

[5] Chiba Univ, Grad Sch Med, Dept Frontier Surg, Chiba, Japan

[6] Chiba Univ, Dept Endocrinol Haematol & Gerontol, Grad Sch Med, Chiba, Japan

[7] Toho Univ, Dept Surg, Sakura Med Ctr, Chiba, Japan

[8] Shiga Univ Med Sci, Dept Med, Otsu, Shiga, Japan

[9] Kohnan Hosp, Dept Surg, Yasu, Shiga, Japan

[10] Oita Univ, Dept Gastroenterol & Pediat Surg, Fac Med, Yufu, Oita, Japan

[11] Iwate Med Univ, Dept Internal Med, Div Diabet Metab & Endocrinol, Morioka, Iwate, Japan

[12] Yotsuya Med Cube, Weight Loss & Metab Surg Ctr, Tokyo, Japan

[13] Tokyo Metropolitan Tama Med Ctr, Dept Endocrinol & Metab, Tokyo, Japan

[14] Mihama Hosp, Dept Internal Med, Chiba, Japan

[15] Osaka Gen Med Ctr, Dept Surg, Osaka, Japan

[16] Oita Univ, Fac Med, Dept Endocrinol Metab Rheumatol & Nephrol, Oita, Japan

[17] Chiba Prefecture Univ Hlth Sci, Chiba, Japan

来源：

OBESITY FACTS | 2023年 / 16卷 / 02期

关键词：

BARIATRIC SURGERY; WEIGHT REGAIN; GASTRIC BYPASS; C-PEPTIDE; METABOLIC SURGERY; AMERICAN SOCIETY; OUTCOMES; PREDICTORS; REMISSION; INSULIN;

D O I：

10.1159/000529546

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Introduction: Laparoscopic sleeve gastrectomy (LSG) for morbidly obese patients often result in remission of type 2 diabetes (T2DM), but diabetes relapses in some of those patients. The frequency of T2DM relapse in Asians and the factors involved have not been adequately investigated. Methods: The J-SMART study was conducted on 322 Japanese subjects with body mass index (BMI) >= 32 kg/m2 who underwent LSG at 10 accredited centers in Japan between 2011 and 2014. Of these, 82 T2DM subjects with diabetes in complete or partial remission at 1 year after LSG and followed postoperatively for 5 years were included in the subgroup analysis, and classified into two groups: diabetes remission maintained and diabetes relapse. Results: The mean age of all included subjects was 49.2 years, median BMI was 41.5 kg/m2, and median was HbA1c 6.7%. Compared with the diabetes remission maintained group, the diabetes relapse group at 5 years after LSG had significantly higher preoperative HbA1c, number of antidiabetic medications, and high-density lipoprotein cholesterol level; and lower BMI and homeostasis model assessment-beta cell function (HOMA-beta). As many as 83.0% of the subjects were able to achieve HbA1c < 7% at 5 years after LSG, but 26.8% of the subjects had diabetes relapse. Preoperative HbA1c significantly contributed to diabetes relapse (odds ratio 1.54, p = 0.049). In addition, the diabetes relapse group tended to have lower percent total weight loss (%TWL) at 1 year after LSG and higher percent weight regain (%WR) from postoperative nadir weight, compared with the diabetes remission maintained group. The hazard ratio for diabetes relapse was 3.14-fold higher in subjects with %TWL >= 20% and %WR >= 25%, and 5.46-fold higher in those with %TWL < 20% and %WR >= 25%, compared with %TWL >= 20% and %WR < 25%. Conclusion: While LSG provides a high remission rate for T2DM, relapse is not uncommon. Preoperative HbA1c, poor weight loss and excess weight regain after LSG contribute to diabetes relapse, suggesting the importance of treatment strategies focusing on these factors.

引用

页码：119 / 130

页数：12

共 57 条

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