ASMBS 2009:胃束帶手術達到明顯的體重減輕、改善糖尿病


  June 29, 2009 (德州達拉斯) — 根據發表於美國代謝與減重手術協會年會的資料,腹腔鏡可調式胃束帶對於第2型糖尿病之病態肥胖患者的代謝參數有明顯而實際的正面影響。
  
  研究者評估95名第2型糖尿病之病態肥胖患者的5年結果,紀錄年紀、性別、種族、身體質量指數(BMI)、糖尿病史、空腹血糖、糖化血色素(HbA1c)、藥物使用狀況。這些病患於2002年1月至2004年6月間接受腹腔鏡可調式胃束帶手術。
  
  病態肥胖的定義為BMI值40 kg/m2以上或者BMI值35 kg/m2合併一種肥胖相關疾病,病患術前的平均年紀為49.3歲,平均罹患糖尿病期間為6.5年。平均術前BMI值為46.3 kg/m2 (範圍:35.1 – 71.9 kg/m2),在追蹤5年時降低至35.0 kg/m2 (範圍:21.1 – 53.7 kg/m2)。平均減輕過量體重達48.3%。
  
  平均空腹血糖值從146 mg/dL降低至118.5 mg/dL (P = .004);平均HbA1c從7.53%降低至術後5年的6.58% (P < .0001)。
  
  糖尿病緩解的定義為,病患不再使用藥物且HbA1c小於6%和/或葡萄糖值小於100 mg/dL。58名病患中有23人(39.7%)達到緩解。改善的定義為,需使用的藥物減少,空腹血糖值介於100-125 mg/dL,57名病患中有41人(71.9%)達到改善。
  
  整體的改善/緩解比率為80%(80名病患中有64人)。
  
  本研究的資深作者之一、紐約市紐約大學醫學院外科副教授Christine Ren醫師表示,我們的研究顯示,對於多數的糖尿病、病態肥胖病患,他們的糖尿病可以有所改善,且通常可以獲得緩解,效果持續到5年。
  
  Ren醫師表示,我們發現,糖尿病完全緩解者與未完全緩解者之間的唯一差異在於體重。
  
  顯然地,藉由胃束帶手術,病患糖尿病緩解或改善的程度,端賴其體重減輕多少與維持狀況。
  
  至於進行胃束帶手術前的診斷期間差別,研究者並未發現對於糖尿病緩解有統計上的顯著差異。胃束帶手術前,94名病患中服用口服藥物的總共有83人(88.3%),有14.9%使用胰島素。胃束帶手術後5年,71名病患中有33 (46.5%)人服用口服藥物,8.5%使用胰島素。
  
  加州Scripps紀念醫院、減重手術計畫醫療主任、美國代謝與減重手術協會執行委員Alan Wittgrove醫師表示,現有胃繞道手術緩解糖尿病效果的證據,不過目前這些結果指出,腹腔鏡可調式胃束帶手術對於糖尿病病態肥胖患者緩解糖尿病和控制代謝參數有效。
  
  Wittgrove醫師表示,這是重要的,因為此研究追蹤病患至少5年,研究顯示,以手術減重而緩解糖尿病患的效果持久,且對代謝症候群有影響。
  
  根據Wittgrove醫師指出,雖然本研究並未發現診斷期間對於糖尿病患改善狀況的影響,但在更大型的研究中仍應將診斷期間視為一個變項。
  
  他表示,這可能是研究強度之一,有許多研究發現,手術時機對於這類病患的糖尿病緩解有影響。越早進行手術,緩解期間越持久。
  
  Wittgrove醫師表示,因為罹病期間在其他研究中顯示有影響, 我推論,如果研究者有更多研究對象,將可以獲得統計上的顯著意義。
  
  該研究為獨立進行。Ren醫師為發言人之一,任職於諮詢委員會,接受Allergan公司提供的研究與教育資金。她接受Ethicon Endo-Surgery公司的研究與教育資金,也擔任Explora Med Development, LLC公司的顧問。Wittgrove醫師為Ethicon Endo-Surgery公司的顧問,接受Stryker公司的研究資金。
  
  美國代謝與減重手術協會2009年會:摘要PL-104。發表於2009年6月24日。
  
  

ASMBS 2009: Gastric Banding Achieves Sustained Weight Loss, Improvement of Diabetes

By Louise Gagnon
Medscape Medical News

June 29, 2009 (Dallas, Texas) — Laparoscopic adjustable gastric banding has a sustained and substantial positive effect on metabolic parameters in morbidly obese patients with type 2 diabetes, according to data presented here at the annual meeting of the American Society of Metabolic and Bariatric Surgery.

Investigators assessed the 5-year outcomes of 95 morbidly obese patients with type 2 diabetes, recording age, sex, race, body mass index (BMI), diabetes history, fasting glucose level, hemoglobin A1c (HbA1c), and use of medications. The patients underwent laparoscopic adjustable gastric banding between January 2002 and June 2004.

Morbid obesity was defined as a BMI of 40 kg/m2 or more or a BMI of 35 kg/m2 with an obesity-related illness. The mean age of patients before surgery was 49.3 years, and mean duration of diabetes was 6.5 years. The mean preoperative BMI was 46.3 kg/m2 (range, 35.1 – 71.9 kg/m2), which fell to 35.0 kg/m2 (range, 21.1 – 53.7 kg/m2) at 5-year follow-up. Mean excess weight loss was 48.3%.

The mean fasting glucose level fell from 146 mg/dL to 118.5 mg/dL (P = .004). The mean HbA1c decreased from 7.53% to 6.58% at 5 years after banding (P < .0001).

Diabetes resolution was defined as the patient being medication-free with an HbA1c of less than 6% and/or a glucose level less than 100 mg/dL. Resolution occurred in 23 (39.7%) of 58 patients. Improvement, defined as fewer medications required and fasting glucose levels between 100 and 125 mg/dL, was seen in 41 (71.9%) of 57 patients.

The overall combined improvement/resolution rate was 80% (64 of 80 patients).

"Our study shows that for the vast majority of diabetic, morbidly obese patients, they will have improvement in their diabetes and often times a resolution of their diabetes, which extends out to 5 years," said Christine Ren, MD, FACS, an associate professor of surgery at New York University School of Medicine in New York City, and one of the study's senior authors.

"We saw [that] the only difference between those who had complete resolution of diabetes vs those who did not was their weight loss," said Dr. Ren.

"It appears that in gastric banding, the probability of a patient having improvement or resolution of diabetes depends on how much weight you lose and keep off."

Investigators did not find a statistically significant difference in remission of diabetes based on the duration of diagnosis prebanding. A total of 83 (88.3%) of 94 patients were on oral medications before gastric banding, and 14.9% were on insulin. Five years after gastric banding surgery, 33 (46.5%) of 71 patients were on oral medications and 8.5% were on insulin.

Evidence has been available on the efficacy of gastric bypass surgery on resolution of diabetes, but these results point to the efficacy of laparoscopic adjustable gastric banding in resolving diabetes and in controlling metabolic parameters in the morbidly obese patient with diabetes, said Alan Wittgrove, MD, FACS, a member of the executive council of the American Society of Metabolic and Bariatric Surgery and medical director of the Bariatric Surgical Program at Scripps Memorial Hospital in La Jolla, California.

"It's important because the study follows the patients for at least 5 years," said Dr. Wittgrove. "It shows the longevity of the procedure in resolving diabetes through weight loss and [its] impact on the metabolic syndrome."

Although the study did not reveal the duration of diagnosis to be a factor that influenced whether or not patients experienced improvement in their diabetes, duration of diagnosis may have emerged as a variable that affected outcomes in a larger study, according to Dr. Wittgrove.

"That is probably a function of the power of the study," he said, noting that several studies have found that the timing of surgery has an effect on resolving diabetes in this type of patient. Surgery performed earlier results in more durable resolution, he pointed out.

"Since [duration of disease] has been shown to be a factor in other studies, I would extrapolate that if [the researchers] get more numbers, it would reach [statistical] significance," Dr. Wittgrove said.

The study was independently conducted. Dr. Ren is a member of the Speaker's Bureau, sits on an advisory board, and receives research and educational grants from Allergan Inc. She receives research and educational grants from Ethicon Endo-Surgery Inc and is a consultant for Explora Med Development, LLC. Dr. Wittgrove is a consultant for Ethicon Endo-Surgery Inc and receives research funding from Stryker Corporation.

American Society of Metabolic and Bariatric Surgery 2009 Annual Meeting: Abstract PL-104. Presented June 24, 2009.

    
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