Using Pre-operative Insulin Dose to Predict Diabetes Remission After Roux-En-Y Gastric Bypass and Sleeve Gastrectomy.

IF 1.2 4区 医学 Q3 SURGERY
Surgical Innovation Pub Date : 2024-10-01 Epub Date: 2024-08-06 DOI:10.1177/15533506241273368
Wissam Ghusn, Yara Salameh, Kamal Abi Mosleh, Meera Shah, Andrew C Storm, Barham K Abu Dayyeh, Omar M Ghanem
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引用次数: 0

Abstract

Background: Obesity is intricately associated with type-2 diabetes (T2D) and other cardiovascular conditions, increasing morbidity, mortality, and health care costs. Metabolic and bariatric surgeries (MBS) have shown promising results in significant weight loss and T2D remission, but existing predictive scores for post-MBS diabetes remission do not consider insulin dosage, potentially overlooking a critical factor.

Methods: A retrospective analysis of patients with T2D who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). The study focused on insulin dosage impact, divided into quartiles, on remission rates post-MBS. The effectiveness of RYGB vs SG was compared within insulin dose quartiles with up to 5 years of follow up.

Results: A total of 508 patients (64% female, 94.9% White, mean age 53.5 ± 10.5 years, BMI (46.0 ± 8.3 kg/m2) were included in the analysis. This study demonstrates a profound association between insulin dosage quartiles and T2D remission after MBS. Patients with lower insulin requirements showed superior remission rates; those in the lowest quartile had remission rates of 73%, 70%, and 62% at 1, 3, and 5 years, respectively, compared to 34%, 37%, and 36% in the highest quartile (P < 0.001 across all intervals). RYGB surgery showed a significantly better remission in the second and third insulin quartiles, suggesting its effectiveness over SG for patients with mid-range insulin requirements.

Conclusion: This study underscores the importance of considering insulin dosage when predicting T2D remission post-MBS. The findings advocate for a more nuanced selection of MBS procedures based on individual insulin profiles, potentially enhancing diabetes remission outcomes.

利用术前胰岛素剂量预测鲁-恩-Y 胃旁路术和袖状胃切除术后糖尿病缓解情况。
背景:肥胖与 2 型糖尿病(T2D)和其他心血管疾病密切相关,会增加发病率、死亡率和医疗费用。代谢和减肥手术(MBS)在显著减轻体重和缓解 T2D 方面取得了良好效果,但现有的代谢和减肥手术后糖尿病缓解预测评分并未考虑胰岛素用量,可能忽略了一个关键因素:对接受 Roux-en-Y 胃旁路术 (RYGB) 或袖状胃切除术 (SG) 的 T2D 患者进行回顾性分析。研究的重点是胰岛素剂量对胃旁路术后缓解率的影响(分为四分位)。在长达 5 年的随访中,在胰岛素剂量四分位数内比较了 RYGB 和 SG 的效果:共有 508 名患者(64% 为女性,94.9% 为白人,平均年龄为 53.5 ± 10.5 岁,体重指数为 46.0 ± 8.3 kg/m2)参与了分析。这项研究表明,胰岛素剂量四分位数与 MBS 后 T2D 缓解之间存在密切联系。胰岛素需求量较低的患者的缓解率较高;胰岛素需求量最低的四分位数患者在 1 年、3 年和 5 年的缓解率分别为 73%、70% 和 62%,而胰岛素需求量最高的四分位数患者的缓解率分别为 34%、37% 和 36%(所有区间的 P <0.001)。RYGB手术在第二和第三胰岛素四分位数中的缓解效果明显更好,这表明对于胰岛素需求处于中等水平的患者,RYGB手术比SG更有效:本研究强调了在预测胰岛素补充术后 T2D 缓解情况时考虑胰岛素用量的重要性。研究结果主张根据个体胰岛素情况对 MBS 程序进行更细致的选择,从而提高糖尿病缓解的效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Surgical Innovation
Surgical Innovation 医学-外科
CiteScore
2.90
自引率
0.00%
发文量
72
审稿时长
6-12 weeks
期刊介绍: Surgical Innovation (SRI) is a peer-reviewed bi-monthly journal focusing on minimally invasive surgical techniques, new instruments such as laparoscopes and endoscopes, and new technologies. SRI prepares surgeons to think and work in "the operating room of the future" through learning new techniques, understanding and adapting to new technologies, maintaining surgical competencies, and applying surgical outcomes data to their practices. This journal is a member of the Committee on Publication Ethics (COPE).
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