SGLT2抑制剂对2型糖尿病患者骨骼的影响

钠葡萄糖共转运体2(sodium-glucose cotransporter 2,SGLT2)抑制剂是一种新型降糖药物,其作用机理是通过抑制肾小管对尿糖的重吸收,以增加尿糖排泄降低血糖。近期来自国外的多个临床药物试验发现SGLT2抑制剂可能对2型糖尿病患者的骨代谢、骨密度以及骨折率产生影响。本文将通过复习国内外相关研究,尝试综述SGLT2抑制剂对2型糖尿病患者骨骼的影响。     

Novel Hypothesis to Explain Why SGLT2 Inhibitors Inhibit Only 30–50% of Filtered Glucose Load in Humans

Inhibitors of sodium-glucose cotransporter 2 (SGLT2) are a novel class of antidiabetes drugs, and members of this class are under various stages of clinical development for the management of type 2 diabetes mellitus (T2DM). It is widely accepted that SGLT2 is responsible for >80% of the reabsorption of the renal filtered glucose load. However, maximal doses of SGLT2 inhibitors fail to inhibit >50% of the filtered glucose load. Because the clinical efficacy of this group of drugs is entirely dependent on the amount of glucosuria produced, it is important to understand why SGLT2 inhibitors inhibit <50% of the filtered glucose load. In this Perspective, we provide a novel hypothesis that explains this apparent puzzle and discuss some of the clinical implications inherent in this hypothesis.Despite the irrefutable evidence for the important role of hyperglycemia in the development of diabetic microvascular complications (1,2) and the large number of antidiabetes agents available for the management of individuals with type 2 diabetes mellitus (T2DM), the majority of subjects with T2DM still manifest suboptimal glycemic control (3). Over half of all patients with T2DM in the U.S. fail to meet the American Diabetes Association treatment goal of HbA_1c <7%, and a smaller number of subjects achieve the American College of Clinical Endocrinologists goal of HbA_1c <6.5% with existing therapies (3). Progressive β-cell failure, weight gain, and hypoglycemia are some of the obstacles for the achievement of optimal glycemic control (HbA_1c ≤6.5) in patients with T2DM. Therefore, additional antidiabetes agents that are effective in lowering the plasma glucose concentration without weight gain and hypoglycemia are required for the treatment of T2DM individuals. Sodium-glucose cotransporter 2 (SGLT2) inhibitors represent a novel class of antihyperglycemic drugs that inhibit glucose reuptake in the kidney and are under clinical development for the treatment of T2DM (4). Dapagliflozin is approved in Europe, and canagliflozin recently was approved in the U.S. This class of drugs lowers the plasma glucose concentration by inhibiting SGLT2, leading to glucosuria. Because SGLT2 inhibitors produce urinary glucose loss, they also promote weight loss. Since the mechanism of action of the SGLT2 inhibitors is independent of insulin action and insulin secretion, they lower the plasma glucose concentration without increasing the risk of hypoglycemia. Moreover, because of this unique mechanism of action, SGLT2 inhibitors are effective in lowering the HbA_1c at all stages of diabetes (5), and they can be used in combination with all other antihyperglycemic agents including insulin (6).The efficacy of SGLT2 inhibitors to reduce the HbA_1c and promote weight loss is highly dependent upon the amount of glucosuria produced by these agents. Clinical studies have demonstrated that the glucosuria produced by these agents is less than would be expected from the inhibition of SGLT2. In this Perspective, we suggest an explanation for this paradox, discuss some of the clinical implications of this explanation, and suggest mechanisms to improve the clinical efficacy of SGLT2 inhibitors.     

Functional annotation and enrichment analysis of differentially expressed serum proteins in patients with type 2 diabetes after dapagliflozin

BACKGROUNDOnly 50% of patients with type 2 diabetes mellitus (T2DM) can control their blood glucose levels. Dapagliflozin is a selective inhibitor of sodium-glucose co-transporter 2 (SGLT-2) that improves the insulin sensitivity of the liver and peripheral tissues. Many studies confirmed that SGLT2 inhibitors reduce blood glucose and have multiple beneficial effects such as weight loss, lipid regulation, and kidney protection. Nevertheless, the mechanisms of the renal and cardiovascular protective effects of dapagliflozin from the perspective of differentially expressed proteins in the serum of T2DM patients have not been intensively explored so far.AIMTo identify differentially expressed proteins associated with dapagliflozin treatment in patients with T2DM.METHODSTwenty T2DM patients [hemoglobin A1c (HbA1c) 7.0%-10.0%] were enrolled at The Affiliated Hospital of Inner Mongolia Medical University between January 1, 2017 and December 1, 2018. They received dapagliflozin (10 mg/d) for 3 mo, and the HbA1c < 7.0% target was achieved. The changes in clinical indexes were compared before and after treatments. Label-free quantitative proteomics was used to identify differentially expressed proteins using the serum samples of five patients. The identified differentially expressed proteins were analyzed using various bioinformatics tools. RESULTSDapagliflozin significantly improved the clinical manifestation of the patients. There were 18 downregulated proteins and one upregulated protein in the serum samples of patients after dapagliflozin administration. Bioinformatics analyses, including subcellular localization, EuKaryotic Orthologous Groups, Gene Ontology, and Kyoto Encyclopedia of Genes and Genomes annotations, were used to profile the biological characteristics of the 19 differentially expressed proteins. Based on the literature and function enrichment analysis, two downregulated proteins, myeloperoxidase (MPO) and alpha II B integrin (ITGA2B), and one upregulated protein, podocalyxin (PCX), were selected for enzyme linked immunosorbent assay validation. These validated differentially expressed proteins had multiple correlations with clinical indexes, including HbAc1 and fasting C-peptide. CONCLUSIONDapagliflozin has hypoglycemic effects and regulates the serum expressions of MPO, ITGA2B, and PCX, possibly contributing to the effects of dapagliflozin on oxidative stress, insulin resistance, and lipid metabolism.     

Effect of Laparoscopic Mini-Gastric Bypass for Type 2 Diabetes Mellitus: Comparison of BMI >35 and <35 kg/m<Superscript>2</Superscript>

Background Laparoscopic gastric bypass resulted in significant weight loss and resolution of type 2 diabetes mellitus (T2DM). The current indication for bariatric surgery is mainly applied for patients with body mass index (BMI) >35 kg/m² with comorbidity status. However, little is known concerning T2DM patients with BMI <35 kg/m². Recent studies have suggested that T2DM patients with BMI <35 kg/m² might benefit from gastric bypass surgery. Methods From Jan 2002 to Dec 2006, 820 patients who underwent laparoscopic mini-gastric bypass were enrolled in a surgically supervised weight loss program. We identified 201 (24.5%) patients who had impaired fasting glucose or T2DM. All the clinical data were prospectively collected and stored. Patients with BMI <35 kg/m² were compared with those of BMI >35 kg/m². Successful treatment of T2DM was defined by HbA1C <7.0%, LDL <100 mg/dl, and triglyceride <150 mg/dl. Results Among the 201 patients, 44 (21.9%) had BMI <35 kg/m², and 114 (56.7%) had BMI between 35and 45, 43 (21.4%) had BMI >45 kg/m². Patients with BMI <35 kg/m² are significantly older, female predominant, had lower liver enzyme and C-peptide levels than those with BMI >35 kg/m². The mean total weight loss for the population was 32.1, 33.4, 31.9, and 32.8% (at 1, 2, 3, 5 years after surgery), and percentage to change in BMI was 31.9, 34.2, 32.2, and 29.5% at 1, 2, 3, and 5 years. One year after surgery, fasting plasma glucose returned to normal in 89.5% of BMI <35 kg/m² T2DM and 98.5% of BMI >35 kg/m² patients (p = 0.087). The treatment goal of T2DM (HbA1C <7.0%, LDL <150 mg/dl and triglyceride <150 mg/dl) was met in 76.5% of BMI <35 kg/m² and 92.4% of BMI >350 kg/m² (p = 0.059). Conclusion Laparoscopic gastric bypass resulted in significant and sustained weight loss with successful treatment of T2DM up to 87.1%. Despite a slightly lower response rate of T2DM treatment, patients with BMI <35 still had an acceptable DM resolution, and this treatment option can be offered to this group of patients.     

降糖药物对骨代谢及骨折风险的影响

2型糖尿病(Type 2 diabetes mellitus,T2DM)是一种发病率很高的慢性病,过去20年进行的一些研究调查了糖尿病(diabetes mellitus,DM)与骨质疏松症及骨代谢之间的关系,脆性骨折(无外伤或较微外伤情况下引起的骨折)增加的风险已经在T2DM患者中表现出来~([1])。在大多数T2DM患者中,抗DM药物对于血糖控制是不可或缺的,然而,它们在骨代谢及对骨折风险有着不同的影响,二甲双胍,磺酰脲类不增加骨折风险,噻唑烷二酮类药物的使用会导致骨质流失加速和骨折风险增加,基于肠降血糖素的治疗方案对骨骼安全性的数据有限,仍需进一步基础及临床研究以明确,钠葡萄糖协同转运蛋白2抑制剂可能通过引发甲状旁腺机能亢进而增加骨折风险,同时,使用胰岛素治疗的患者可能需更多关注DM并发症及低血糖所致的骨折风险增加。本文拟对降糖药物T2DM患者骨代谢及骨折风险的影响作一综述,为T2DM患者药物降糖治疗提供指导。     

十二指肠空肠旁路术治疗非过度肥胖2型糖尿病七例

目的探讨十二指肠空肠旁路术（DJB）治疗非过度肥胖型2型糖尿病（T2DM）的疗效和可行性。方法随访并检测7例行十二指肠空肠旁路术的非过度肥胖型T2DM患者术前和术后24周内的体质量指数（BMI）、空腹血糖（FPG）、餐后2h血糖（2hPG）、空腹胰岛素（F-ins）、空腹C肽（F-CP）和糖化血红蛋白（HbAlc）,结合患者所应用的降糖药物剂量的变化,分析术后24周患者T2DM转归情况。结果接受DJB的7例T2DM患者．1例完全脱离降糖药物,FBG、2hPG和HbAlc正常;5例应用降糖药物剂量明显减少,但尚未完全脱离药物：1例无明显改善。血糖完全缓解比例1／7,有效比例6／7,HbAlc达标比例5／7：患者术后各时间段BMI较术前均无明显变化。结论十二指肠空肠旁路术可以降低非过度肥胖T2DM患者的血糖．其对血糖的控制不依赖于体质量的降低．机制尚未完全明确。     

Diabetes remission and reduced cardiovascular risk after gastric bypass in Asian Indians with body mass index <35 kg/m2

BackgroundRoux-en-Y gastric bypass (RYGB) benefits patients with type 2 diabetes mellitus (T2DM) and a body mass index (BMI) >35 kg/m²; however, its effectiveness in patients with T2DM and a BMI <35 kg/m² is unclear. Asian Indians have a high risk of T2DM and cardiovascular disease at relatively low BMI levels. We examined the safety and efficacy of RYGB in Asian Indian patients with T2DM and a BMI of 22–35 kg/m² in a tertiary care medical center.MethodsA total of 15 consecutive patients with T2DM and a BMI of 22–35 kg/m² underwent RYGB. The data were prospectively collected before surgery and at 1, 3, 6, and 9 months postoperatively.ResultsOf the 15 patients, 8 were men and 7 were women (age 45.6 ± 12 years). Their preoperative characteristics were BMI 28.9 ± 4.0 kg/m², body weight 78.7 ± 12.5 kg, waist circumference 100.2 ± 6.8 cm, and duration of T2DM 8.7 ± 5.3 years. At baseline, 80% of subjects required insulin, and 20% controlled their T2DM with oral hypoglycemic medication. The BMI decreased postoperatively by 20%, from 28.9 ± 4.0 kg/m² to 23.0 ± 3.6 kg/m² (P <.001). All antidiabetic medications were discontinued by 1 month after surgery in 80% of the subjects. At 3 months and thereafter, 100% were euglycemic and no longer required diabetes medication. The fasting blood glucose level decreased from 233 ± 87 mg/dL to 89 ± 12 mg/dL (P <.001), and the hemoglobin A1c decreased from 10.1% ± 2.0% to 6.1% ± 0.6% (P <.001). Their waist circumference, presence of dyslipidemia, and hypertension improved significantly. The predicted 10-year cardiovascular disease risk (calculated using the United Kingdom Prospective Diabetes Study equations) decreased substantially for fatal and nonfatal coronary heart disease and stroke. No mortality, major surgical morbidity, or excessive weight loss occurred.ConclusionRYGB safely and effectively eliminated T2DM in Asian Indians with a BMI <35 kg/m². Larger, longer term studies are needed to confirm this benefit.     

Vildagliptin-insulin combination improves glycemic control in Asians with type 2 diabetes

AIM: To assess the efficacy and safety of vildagliptin 50 mg bid as add-on therapy to insulin in Asian patients with type 2 diabetes mellitus (T2DM).METHODS: This was a post hoc analysis of a subgroup of Asian patients from a multicenter, randomized, double-blind, placebo-controlled, parallel-group study in T2DM patients inadequately controlled by stable insulin therapy, with or without metformin. A total of 173 patients were randomized 1:1 to receive treatment with vildagliptin 50 mg bid (n = 87) or placebo (n = 86) for 24 wk. Changes in HbA1c and fasting plasma glucose (FPG), from baseline to study endpoint, were analyzed using an analysis of covariance model. Change from baseline to endpoint in body weight was summarized by treatment. Safety and tolerability of vildagliptin was also evaluated.RESULTS: After 24 wk, the difference in adjusted mean change in HbA1c between vildagliptin and placebo was 0.82% (8.96 mmol/mol; P < 0.001) in Asian subgroup, 0.85% (9.29 mmol/mol; P < 0.001) in patients also receiving metformin, and 0.73% (7.98 mmol/mol; P < 0.001) in patients without metformin, all in favor of vildagliptin. There was no significant difference in the change in FPG between treatments. Weight was stable in both treatment groups (+0.3 kg and -0.2 kg, for vildagliptin and placebo, respectively). Overall, vildagliptin was safe and well tolerated with similarly low incidences of hypoglycemia (8.0% vs 8.1%) and no severe hypoglycemic events were experienced in either group.CONCLUSION: In Asian patients inadequately controlled with insulin (with or without concomitant metformin), insulin-vildagliptin combination treatment significantly reduced HbA1c compared with placebo, without an increase in risk of hypoglycemia or weight gain.     

Glucose handling by the kidney

The kidney contributes to glucose homeostasis through processes of gluconeogenesis, glucose filtration, glucose reabsorption, and glucose consumption. Each of these processes can be altered in patients with type-2 diabetes (T2DM), providing potential targets for novel therapies. Recent studies have indicated that the kidney is responsible for up to 20% of all glucose production via gluconeogenesis. In patients with T2DM, overall glucose production increases by as much as 300%, with equal contributions from hepatic and renal sources. This increased production contributes not only to increased fasting glucose in T2DM patients but also to raised postprandial glucose because, in contrast to the liver, glucose ingestion increases renal gluconeogenesis. Under normal circumstances, up to 180 g/day of glucose is filtered by the renal glomerulus and virtually all of it is subsequently reabsorbed in the proximal convoluted tubule. This reabsorption is effected by two sodium-dependent glucose cotransporter (SGLT) proteins. SGLT2, situated in the S1 segment, is a low-affinity high-capacity transporter reabsorbing up to 90% of filtered glucose. SGLT1, situated in the S3 segment, is a high-affinity low-capacity transporter reabsorbing the remaining 10%. In patients with T2DM, renal reabsorptive capacity maladaptively increases from a normal level of 19.5 to 23.3 mmol/l/min. Once glucose has been reabsorbed into the tubular epithelial cells, it diffuses into the interstitium across specific facilitative glucose transporters (GLUTs). GLUT1 and GLUT2 are associated with SGLT1 and SGLT2, respectively.     

腹腔镜胃旁路术治疗2型糖尿病效果探讨

目的探讨腹腔镜胃旁路术（LGBP）治疗2型糖尿病的临床效果。方法回顾性分析2008年1月至2011年6月72例2型糖尿病患者行LGBP治疗前后及其随访的临床资料,比较治疗前后糖尿病相关指标的变化和并发症的改善情况。结果72例均顺利完成LGBP,无死亡病例,患者术后空腹血糖、餐后2h血糖、c肽、糖化血红蛋白、体重指数明显低于术前（P〈0．01）,28例合并有眼底病变、手足麻木等症状的患者中21例有不同程度的改善。随访12个月以上,无远期并发症发生。结论LGBP在治疗2型糖尿病及改善糖尿病并发症方面具有肯定效果。     

Type 2 Diabetes Mellitus in Patients with Mild Obesity: Preliminary Results of Surgical Treatment

In the last years, type 2 diabetes mellitus (T2DM) and obesity have become a serious public health problem, behaving as epidemic diseases. There is great interest in exploring different options for the treatment of T2DM in nonmorbidly obese patients. The purpose of this study is to report parameters of glycemic control in patients with T2DM and mild obesity who underwent laparoscopic Roux-en-Y gastric bypass (RYGBP). This prospective clinical trial includes patients with T2DM with a body mass index (BMI) between 30 and 35 kg/m² who underwent laparoscopic RYGBP from July 2008 through October 2010. Thirty-one patients were included in the study, 15 men and 16 women, with an average age of 48.7?±?8.6 years. The average time since onset of T2DM was 5.8 years. The average postoperative follow-up was 30.4 months. The average preoperative blood glucose and glycosylated hemoglobin were 152?±?70 mg/dl and 7.7?±?2.1 %, respectively. All of them were using oral hypoglycemic agents, and four patients were insulin dependent. Only one patient had a postoperative complication (hemoperitoneum). At 36 months follow-up, the average BMI decreased to 24.7 kg/m², all patients (31) showed improvement in their glycemic control, and 29 of them (93.6 %) met the criteria for remission of T2DM in the last control. Laparoscopic RYGBP is a safe and effective procedure that improves glycemic control in patients with T2DM and mild obesity at midterm follow-up.     

Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up

BackgroundStudies have shown that type 2 diabetes (T2DM) improves or resolves shortly after Roux-en-Y gastric bypass (RYGB). Few data are available on T2DM recurrence or the effect of weight regain on T2DM status.MethodsA review of 42 RYGB patients with T2DM and ≥3 years of follow-up and laboratory data was performed. Postoperative weight loss and T2DM status was assessed. Recurrence or worsening was defined as hemoglobin A1c >6.0% and fasting glucose >124 mg/dL and/or medication required after remission or improvement. Patients whose T2DM recurred or worsened were compared with those whose did not, and patients whose T2DM improved were compared with those whose T2DM resolved.ResultsT2DM had either resolved or improved in all patients (64% and 36%, respectively); 24% (10) recurred or worsened. The patients with recurrence or worsening had had a lower preoperative body mass index than those without recurrence or worsening (47.9 versus 52.9 kg/m2; P = .05), regained a greater percentage of their lost weight (37.7% versus 15.4%; P = .002), had a greater weight loss failure rate (63% versus 14%; P = .03), and had greater postoperative glucose levels (138 versus 102 mg/dL; P = .0002). Patients who required insulin or oral medication before RYGB were more likely to experience improvement rather than resolution (92% versus 8%, P ≤.0001; and 85% versus 15%; P = .0006, respectively).ConclusionOur results have shown that beyond 3 years after RYGB, the incidence of T2DM recurrence or worsening in patients with initial resolution or improvement was significant. In our patients, a greater likelihood of recurrence or worsening of T2DM was associated with a lower preoperative body mass index. Before widespread acceptance of bariatric surgery as a definitive treatment for those with T2DM can be achieved, additional study of this recurrence phenomenon is indicated.     

Laparoscopic treatment of type 2 diabetes mellitus for patients with a body mass index less than 35

Background Type 2 diabetes mellitus (T2DM) is a common disease with numerous complications. Bariatric surgery is an efficient procedure for controlling T2DM in morbidly obese patients. In T2DM, the incretin effect is either greatly impaired or absent. This study aimed to evaluate the preliminary results from interposing a segment of ileum into the proximal jejunum associated with a sleeve or diverted sleeve gastrectomy to control T2DM in patients with a body mass index (BMI) less than 35 kg/m². Methods For this study, 39 patients (16 women and 23 men) underwent two laparoscopic procedures comprising different combinations of ileal interposition into the proximal jejunum via a sleeve or diverted sleeve gastrectomy. The mean age of these patients was 50.3 years (range, 36–66 years). The mean BMI was 30.1 kg/m² (range, 23.4–34.9 kg/m²). All the patients had a diagnosis of T2DM that had persisted for at least 3 years and evidence of stable treatment with oral hypoglycemic agents or insulin for at least 12 months. The mean duration of T2DM was 9.3 years (range, 3–22 years). Results The mean operative time was 185 min, and the median hospital stay was 4.3 days. Four major complications occurred in the short term (30-days), and the mortality rate was 2.6%. The mean postoperative follow-up period was 7 months (range, 4–16 months), and the mean percentage of weight loss was 22%. The mean postoperative BMI was 24.9 kg/m² (range, 18.9–31.7 kg/m²). An adequate glycemic control was achieved for 86.9% of the patients, and 13.1% had important improvement. The patients whose glycemia was not normalized were using a single oral hypoglycemic agent. No patient needed insulin therapy postoperatively. All the patients except experienced normalization of their cholesterol levels. Targeted triglycerides levels were achieved by 71% of the patients, and hypertension was controlled for 95.8%. Conclusions The laparoscopic ileal interposition via either a sleeve gastrectomy or diverted sleeve gastrectomy seems to be a promising procedure for the control of T2DM and the metabolic syndrome. A longer follow-up period is needed.     

腹腔镜下袖状胃切除术治疗高体重指数2型糖尿病的效果分析

目的探讨腹腔镜袖状胃切除术(LSG)治疗高体重指数2型糖尿病(T2DM)患者的可行性及疗效的稳定性。 方法回顾性分析2010年至2016年间两个医院24例实施LSG的T2DM患者的临床资料,所有数据建立完整的excel表格,采用SPSS 17.0分析。术前术后体重和糖化血红蛋白(HBALc)水平以( ±s)表示,采用t检验;分类数据以频率和百分比表示,采用卡方检验。P<0.05认为差异有统计学意义。 结果24例患者平均基线体重为(117.2±30.2) kg,在术后3个月、6个月、12个月和24个月时显著下降至(100.3±22.1) kg、(91.6±22.4) kg、(81.3±16.5) kg和(80.3±14.3) kg, P<0.001。术前平均基线HbA1c为(8.5±2.2)%,分别在3个月、6个月、12个月和24个月显著降低至(6.4±1.6)%,(5.8±1.1)%, (5.7±0.7)%和(5.3±0.6)% P<0.001。19例接受袖状胃切除术的T2DM患者停止使用胰岛素和口服降糖药,根据血糖控制标准,24例患者24个月缓解率达79.2%。除1例继续使用2种降压药外,其余高血压患者(17例)停止降压药治疗。 结论LSG治疗高体重T2DM患者,方法简单,手术安全,治疗效果确切,值得在临床中普遍推广应用。     

Duodenal-jejunal bypass for the treatment of type 2 diabetes in Chinese patients with an average body mass index<24 kg/m2

BackgroundIt is frequently reported that bariatric surgery often leads to resolution of type 2 diabetes mellitus (T2 DM). Limited experience with duodenal-jejunal bypass (DJB) for the treatment of T2 DM has shown controversial results. We present the first study of DJB for T2 DM patients in China. The objective of this study was to evaluate the effects of DJB in nonobese Chinese patients with T2 DM.MethodsFrom March 2009 to March 2011, a total of 10 T2 DM patients with an average body mass index (BMI) of 23.8±1.2 kg/m² were enrolled in the study. DJB was performed in all patients. BMI and glycometabolic parameters were collected at baseline and 1, 3, 6, 12, and 24 months postoperatively. Remission of T2 DM was defined as a glycosylated hemoglobin (HbA_1c) level of<7% without diabetic medication.ResultsRemission of T2 DM was observed in 1 (10%) of 10 T2 DM patients at 6 months. Without increasing antihyperglycemic agents, fasting plasma glucose (FPG), 2-hour postprandial plasma glucose, and HbA_1c decreased significantly at each postoperative time point, compared with the preoperative baseline. BMI statistically decreased at 1 and 3 months, but did not reach statistical significance at 6, 12, and 24 months.ConclusionsDJB can improve glycemic control in nonobese T2 DM patients without significant weight loss but may not be effective enough to induce remission of T2 DM in nonobese Chinese patients. A larger sample size and more constrictive inclusion criteria may be required for better evaluation.     

不同血糖监测频次对住院2型糖尿病患者医疗花费及血糖控制情况的调查研究

目的：探讨住院T2DM患者不同血糖监测频次对住院天数、医疗花费及血糖控制情况方面的影响。方法随机选取在我院住院治疗的T2DM患者1000例，根据住院期间血糖监测频数，分为5点血糖监测组和7点血糖监测组。所有患者在空腹血糖≤7.0mmol/L，餐后血糖＜10.0mmol/L，血糖平稳2d后出院。比较两组患者住院天数、医疗花费及血糖控制情况方面的不同。结果7点血糖监测组患者较5点血糖监测组住院天数明显缩短、总住院费用、药品费用、治疗费用明显降低（P＜0.05），但两组患者检查化验费用及日治疗费用差异无统计学意义（P＞0.05）。在血糖控制方面，7点血糖监测组较5点血糖监测组可以更有效地控制血糖平稳达标，减少血糖波动。结论住院T2DM患者每日7点血糖监测明显缩短住院天数、降低住院花费，有效控制血糖，减少血糖波动。     

Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus

OBJECTIVE: To evaluate pre- and postoperative clinical parameters associated with improvement of diabetes up to 4 years after laparoscopic Roux-en-Y gastric bypass (LRYGBP) in patients with type 2 diabetes mellitus (T2DM). SUMMARY BACKGROUND DATA: The surgical treatment of morbid obesity leads to dramatic improvement in the comorbidity status of most patients with T2DM. However, little is known concerning what preoperative clinical factors are associated with postoperative long-term improvement in diabetes in the morbidly obese patient with diabetes.METHODS We evaluated pre- and postoperative data, including demographics, duration of diabetes, metabolic parameters, and clinical outcomes, in all patients with impaired fasting glucose (IFG) and type T2DM undergoing LRYGBP from July 1997 to May 2002. RESULTS: During this 5-year period, 1160 patients underwent LRYGBP and 240 (21%) had IFG or T2DM. Follow up was possible in 191 of 240 patients (80%). There were 144 females (75%) with a mean preoperative age of 48 years (range, 26-67 years). After surgery, weight and body mass index decreased from 308 lbs and 50.1 kg/m2 to 211 lbs and 34 kg/m2 for a mean weight loss of 97 lbs and mean excess weight loss of 60%. Fasting plasma glucose and glycosylated hemoglobin concentrations returned to normal levels (83%) or markedly improved (17%) in all patients. A significant reduction in use of oral antidiabetic agents (80%) and insulin (79%) followed surgical treatment. Patients with the shortest duration (<5 years), the mildest form of T2DM (diet controlled), and the greatest weight loss after surgery were most likely to achieve complete resolution of T2DM. CONCLUSION: LRYGBP resulted in significant weight loss (60% percent of excess body weight loss) and resolution (83%) of T2DM. Patients with the shortest duration and mildest form of T2DM had a higher rate of T2DM resolution after surgery, suggesting that early surgical intervention is warranted to increase the likelihood of rendering patients euglycemic.     

Laparoscopic Roux-en-Y gastric bypass for nonobese type II diabetes mellitus in Asian patients

BackgroundThe beneficial role of laparoscopic Roux-en-Y gastric bypass (LRYGB) for type 2 diabetes mellitus (T2 DM) in morbidly obese patients has been established; however, there is scant evidence supporting its effectiveness in nonobese T2 DM Asian patients. The objective of this study was to evaluate the effect of LRYGB in nonobese T2 DM patients and elucidate the predictors of DM remission after one year follow-up.MethodsBetween June 2009 and May 2011, twenty-nine nonobese (body mass index (BMI)<27 kg/m²) Asian patients with T2 DM who underwent LRYGB were enrolled. All patients were prospectively followed up for one year. Baseline demographic characteristics, diabetic status, and clinical and biochemical data were collected preoperatively and one year after LRYGB. DM remission was defined as those with hemoglobin A1 c (HbA1 c)<6.5% without oral hypoglycemic drugs (OHA)/insulin. Outcomes in the DM remission group were compared with the nonremission group and analyzed.ResultsAll clinical and biochemical parameters, except uric acid, were significantly improved. DM remission was achieved in eleven patients (37.9%) of whom five (45.5%) were male. Blood glucose, HbA1 c, c-peptide, homeostatic model assessment (HOMA-%B), and low density lipoprotein (LDL)-cholesterol were the significant variables in patients with DM remission; however, multiple logistic regression showed that only preoperative HOMA-%B (odds ratio (OR) = 1.13, 95% CI = 1.03-1.24) was a predictor for DM remission. Though no mortality was seen, the complication rate was 20.7%, of which 17.3% was related to marginal ulcers.ConclusionLRYGB resulted in significant clinical and biochemical improvements in nonobese Asian patients, with HOMA-%B indicating β-cell function as the main predictor of T2 DM remission. Appropriate patient selection with better β-cell function and evidence from long-term follow-up may justify this therapeutic approach.     

Analysis of factors associated with durable remission of diabetes after Roux-en-Y gastric bypass

BackgroundData on the durability of remission of type 2 diabetes mellitus (T2DM) after gastric bypass are limited. Our purpose was to identify the rate of long-term remission of T2DM and the factors associated with durable remission.MethodsA total of 177 patients with T2DM who had undergone Roux-en-Y gastric bypass from 1993 to 2003 had 5-year follow-up data available. T2DM status was determined by interview and evaluation of the diabetic medications. Patients with complete remission or recurrence of T2DM were identified.ResultsFollow-up ranged from 5 to 16 years. Of the 177 patients, 157 (89%) had complete remission of T2DM with a decrease in their mean body mass index from baseline (50.2 ± 8.2 kg/m²) to 31.3 ± 7.2 kg/m² postoperatively (mean percentage of excess weight loss 70.0% ± 18.6%). However, 20 patients (11.3%) did not have T2DM remission despite a mean percentage of excess weight loss of 58.2% ± 12.3% (P <.0009). Of the 157 patients with initial remission of their T2DM, 68 (43%) subsequently developed T2DM recurrence. Remission of T2DM was durable in 56.9%. Durable (>5-year) resolution of T2DM was greatest in the patients who originally had either controlled their T2DM with diet (76%) or oral hypoglycemic agents (66%). The rate of T2DM remission was more likely to be durable in men (P = .00381). Weight regain was a statistically significant, but weak predictor, of T2DM recurrence.ConclusionEarly remission of T2DM occurred in 89% of patients after Roux-en-Y gastric bypass. T2DM recurred in 43.1%. Durable remission correlated most closely with an early disease stage at gastric bypass.     

Sleeve Gastrectomy with Jejunal Bypass for the Treatment of Type 2 Diabetes Mellitus in Patients with Body Mass Index <35?kg/m2. A cohort study

The objective of this study was to evaluate sleeve gastrectomy with jejunal bypass (SGJB) as a surgical treatment for type 2 diabetes mellitus (T2DM) in patients with a body mass index (BMI) <35 kg/m(2). This is a prospective cohort study. Patients with T2DM and BMI <35 kg/m(2) who underwent SGJB between January 2009 and June 2011 at DIPRECA Hospital, in Santiago, and Hospital Base, Osorno, Chile were included. SGJB consists of creating a gastric tube, which preserves the pylorus, and performing a jejunoileal anastomosis 300 cm distal to the angle of Treitz. Excess weight loss (EWL) and complete or partial remission of T2DM were reported. Forty-nine patients met the inclusion criteria. The mean age was 49 years (36-62), and 53 % of patients were female. Mean preoperative BMI was 31.6 kg/m(2) (25-34.9 kg/m(2)). Operation time was 123 ± 14 min, with 94.7 % of operations performed laparoscopically. Mean postoperative hospital stay was 2 days. Mean postoperative follow-up was 12 months. Median EWL at 1, 3, 6, 12, and 18 months postoperatively was 31.9 %, 56.9 %, 76.1 %, 81.5 %, and 76.1 %, respectively. Complete T2DM remission was achieved in 81.6 % of patients (40/49) and partial remission in 18.4 % (9/49). Forty of 41 patients (97.6 %) on oral hypoglycemic agents achieved complete T2DM remission, and 100 % of insulin-dependent patients stopped using insulin but were still being treated for T2DM. One patient experienced postoperative gastrointestinal bleeding. There were no deaths. SGJB is an effective treatment for T2DM in patients with BMI <35 kg/m(2).