饮食与胃旁路手术对糖尿病患者代谢功能的影响相差不大 作者： 发布时间：/8/21 19:20:37 美国华盛顿大学医学院Samuel Klein团队研究了饮食和胃旁路手术减重对糖尿病代谢功能的影响。该成果于8月20日发表在《新英格兰医学杂志》上。
一些研究表明，在2型糖尿病患者中，Roux-en-Y胃旁路术可改善代谢功能，且与体重减轻无关。
研究组招募了22例肥胖和糖尿病患者，这些患者经胃旁路术（手术组）或单纯饮食（饮食组）控制后体重减轻约18%，研究组对他们的葡萄糖稳态代谢调节因子进行评估。主要结局是肝脏胰岛素敏感性的变化，通过低速胰岛素输注进行评估。次要结局是肌肉胰岛素敏感性、 细胞功能、24小时血糖和胰岛素谱的变化。
体重减轻与血糖生成的平均抑制增加有关，在钳夹第1阶段，饮食组为7.04 mol/kg（去脂体重）/min，手术组为7.02 mol/kg（去脂体重）/min；钳夹第2阶段，两组分别为5.39和5.37 mol/kg（去脂体重）/min，组间无显著差异。体重减轻与胰岛素刺激的葡萄糖处理增加有关，饮食组的去脂体重从30.5增加到61.6 mol/kg/min，手术组则从29.4增加到54.5 mol/kg/min，组间无显著差异。
体重减轻后，饮食组的 细胞功能（相对于胰岛素敏感性的胰岛素分泌）增加了1.83个单位，手术组增加了1.11个单位，组间无显著差异；两组24小时血浆葡萄糖和胰岛素水平曲线下的面积显著降低，但组间亦无显著差异。两组患者均无严重并发症发生。
总之，对于肥胖和2型糖尿病患者，胃旁路手术和饮食减重的代谢益处相差不大。
附：英文原文
Title: Effects of Diet versus Gastric Bypass on Metabolic Function in Diabetes
Author: Mihoko Yoshino, M.D., Ph.D.,, Brandon D. Kayser, Ph.D.,, Jun Yoshino, M.D., Ph.D.,, Richard I. Stein, Ph.D.,, Dominic Reeds, M.D.,, J. Christopher Eagon, M.D.,, Shaina R. Eckhouse, M.D.,, Jeramie D. Watrous, Ph.D.,, Mohit Jain, M.D., Ph.D.,, Rob Knight, Ph.D.,, Kenneth Schechtman, Ph.D.,, Bruce W. Patterson, Ph.D.,, and Samuel Klein, M.D.
Issue Volume: -08-19
Abstract:
Background
Some studies have suggested that in people with type 2 diabetes, Roux-en-Y gastric bypass has therapeutic effects on metabolic function that are independent of weight loss.
Methods
We evaluated metabolic regulators of glucose homeostasis before and after matched (approximately 18%) weight loss induced by gastric bypass (surgery group) or diet alone (diet group) in 22 patients with obesity and diabetes. The primary outcome was the change in hepatic insulin sensitivity, assessed by infusion of insulin at low rates (stages 1 and 2 of a 3-stage hyperinsulinemic euglycemic pancreatic clamp). Secondary outcomes were changes in muscle insulin sensitivity, beta-cell function, and 24-hour plasma glucose and insulin profiles.
Results
Weight loss was associated with increases in mean suppression of glucose production from baseline, by 7.04 mol per kilogram of fat-free mass per minute (95% confidence interval [CI], 4.74 to 9.33) in the diet group and by 7.02 mol per kilogram of fat-free mass per minute (95% CI, 3.21 to 10.84) in the surgery group during clamp stage 1, and by 5.39 (95% CI, 2.44 to 8.34) and 5.37 (95% CI, 2.41 to 8.33) mol per kilogram of fat-free mass per minute in the two groups, respectively, during clamp stage 2; there were no significant differences between the groups. Weight loss was associated with increased insulin-stimulated glucose disposal, from 30.5 15.9 to 61.6 13.0 mol per kilogram of fat-free mass per minute in the diet group and from 29.4 12.6 to 54.5 10.4 mol per kilogram of fat-free mass per minute in the surgery group; there was no significant difference between the groups. Weight loss increased beta-cell function (insulin secretion relative to insulin sensitivity) by 1.83 units (95% CI, 1.22 to 2.44) in the diet group and by 1.11 units (95% CI, 0.08 to 2.15) in the surgery group, with no significant difference between the groups, and it decreased the areas under the curve for 24-hour plasma glucose and insulin levels in both groups, with no significant difference between the groups. No major complications occurred in either group.
Conclusions
In this study involving patients with obesity and type 2 diabetes, the metabolic benefits of gastric bypass surgery and diet were similar and were apparently related to weight loss itself, with no evident clinically important effects independent of weight loss.
DOI: NJ3830809
Source:
期刊信息
The New England Journal of Medicine：《新英格兰医学杂志》，创刊于18。隶属于美国麻省医学协会，最新IF：70.67
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