Clinical efficacy and influencing factors of the laparoscopic Roux-en-Y gastric bypass and metformin in the treatment of obese patients with type 2 diabetes mellitus
10.3760/cma.j.issn.1673-9752.2017.06.009
- VernacularTitle:腹腔镜胃旁路术和二甲双胍治疗肥胖症合并2型糖尿病的临床疗效及影响因素分析
- Author:
Jie ZHAO
;
Junjiang LI
;
Yunhai ZHU
;
Wen LI
- Keywords:
Obesity;
Diabetes mellitus,type 2;
Gastric bypass;
Metformin;
Laparoscopy
- From:
Chinese Journal of Digestive Surgery
2017;16(6):575-581
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the clinical efficacy of the laparoscopic Roux-en-Y gastric bypass (LRYGB) and metformin in the treatment of obese patients with type 2 diabetes mellitus,and influencing factors of remission rate of diabetes.Methods The case-control study was conducted.The clinical data of 172 obese patients with type 2 diabetes mellitus who were admitted to the First People's Hospital of Shangqiu (43 patients) and the First Affiliated Hospital of Sun Yat-sen University (129 patients) from June 2010 to June 2015 were collected.Of 172 patients,82 undergoing LRYGB were allocated into the group A and 90 taking oral metformin were allocated into the group B.Observation indicators:(1) follow-up situations;(2) comparison of metabolic indices after treatment between the 2 groups;(3) influencing factors analysis of remission rate of diabetes in patients undergoing LRYGB;(4) influencing factors analysis of remission rate of diabetes in patients taking oral metformin.Follow-up using outpatient examination and telephone interview was performed to detect occurrence of treatment-related complications up to January 2017,and metabolic indices were measured regularly.Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the independent-sample t test.Repeated measurement data were analyzed by the repeated measures ANOVA.Comparisons of count data were evaluated by the chi-square test.The univariate analysis and multivariate analysis were respectively done using the chi-square test and Logistic regression model.Results (1) Follow-up situations:172 patients were followed up after treatment for 19-43 months,with a median time of 28 months.During the follow-up,5 patients complicated with mild diarrhea and 1 complicated with iron deficiency anemia at 1 year postoperatively were improved by symptomatic treatment in the group A,and there was no treatment-related complications in the group B.(2) Comparison of metabolic indices after treatment between 2 groups:body mass,BMI,2-hour postprandial blood glucose (2HPBG),2-hour postprandial serum C-peptide,glycosylated hemoglobin (GHb),fasting insulin,2-hour postprandial insulin (2HPI),low-density lipoprotein (LDL) and cases with hypertension in the group A were (89±6) kg,(31.5±2.0) kg/m2,(19.4±3.9) mmol/L,(3.52± 0.32) μg/L,15.7％ ±5.3％,(8.0± 1.4) uIU/L,(20.6± 2.5) uIU/L,(3.7 ± 1.3) mmol/L,24 before LRYGB and(77±16)kg,(24.2±2.9)kg/m2,(10.6±2.6) mmol/L,(7.19± 2.23) μg/L,5.3％±4.5％,(9.2± 4.3)uIU/L,(28.3±2.9)uIU/L,(2.2±2.1)mmol/L,9 after LRYGB,respectively,with statistically significant differences between preoperative and postoperative indicators (F=2.112,3.026,1.253,2.107,1.257,3.473,1.223,2.584,x2 =8.540,P ＜ 0.05).Fasting blood glucose,2HPBG,fasting serum C-peptide,2-hour postprandial serum C-peptide,GHb,fasting insulin and 2HPI in the group B were (11.3±2.5)mmol/L,(18.5± 4.4) mmol/L,(1.54±0.33) μg/L,(3.57±0.91) μg/L,17.5％ ±8.0％,(8.2± 1.3) uIU/L,(21.2±2.6) uIU/L before taking oral metformin and (6.6 ± 1.1) mmol/L,(10.2 ± 2.8) mmol/L,(3.52 ± 1.34) μg/L,(7.68 ± 1.94) μg/L,5.4％ ±2.1％,(9.6± 3.9) uIU/L,(30.3± 3.1) uIU/L after taking oral metformin,respectively,with statistically significant differences between before and after taking oral metformin (F=1.245,3.224,3.127,2.064,3.672,2.074,1.137,P＜0.05).Remission rate of diabetes and excess weight loss (EWL) in patients after treatment were 14.6％,80％ ± 15％ in the group A and 11.1％,60％ ± 10％ in the group B,respectively.There were statistically significant differences in body mass,BMI and EWL after treatment between the 2 groups (t=1.973,2.326,2.347,P＜0.05),and no statistically significant difference in remission rate of diabetes between the 2 groups (x2 =0.477,P＞0.05).(3) Influencing factors analysis of remission rate of diabetes in patients undergoing LRYGB:the results of univariate analysis showed that BMI,diabetes duration and LDL were factors affecting remission rate of diabetes in patients undergoing LRYGB,with statistically significant differences (x2=11.267,9.519,5.567,P＜0.05).The results of multivariate analysis showed that diabetes duration ＜ 10 years was an independent factor affecting good remission rate of diabetes in patients undergoing LRYGB,with statistically significant differences [OR=2.202,95％ confidence interval (CI):1.418-3.420,P＜0.05].(4) Influencing factors analysis of remission rate of diabetes in patients taking oral metformin:the results of univariate analysis showed that diabetes duration,GHb and LDL were factors affecting remission rate of diabetes in patients taking oral metformin,with statistically significant differences (x2 =6.306,7.758,4.652,P＜0.05).The results of multivariate analysis showed that GHb ＜ 15.0％ was an independent factor affecting good remission rate of diabetes in patients taking oral metformin,with statistically significant differences (OR=3.167,95％CI:1.586-6.325,P＜0.05).Conclusions LRYGB and oral metformin in the treatment of obese patients with type 2 diabetes mellitus are safe and effective,showing an equivalent remission rate of diabetes,and LRYGB had an advantage of weight loss.Diabetes duration ＜ 10 years and GHb ＜ 15.0％ are respectively independent factors affecting good remission rate of diabetes in patients undergoing LRYGB and taking oral metformin.
