| BACKGROUND:Obesity and type 2 diabetes mellitus(T2DM)are prevalent all over the world,which seriously threaten people’s health and even their safety.Traditional treatments including oral hypoglycemic drugs,diet control and other conservative treatment in control of blood sugar has achieved good results.But it needs patients to persist for a long time,and affected by liver,kidney and other organ functions,the weight loss effect is poor,and easy to rebound.Bariatric and metabolic surgery is a branch of surgery that has developed rapidly in recent years,it has been paid more and more attention.The purpose is to carry out surgical intervention on obese patients and patients with T2 DM,so as to achieve a lasting effect of weight loss and hypoglycemia.At present,weight-loss surgery is mainly divided into three types:restrictive,malabsorptive,combined restrictive and malabsorptive.Restrictive type including vertical band gastroplasty(VBG),adjustable gastric banding(AGB),sleeve gastrectomy(SG).Malabsorptive type including Biliopancreatic diversion(BPD)and mixed gastric bypass(GBP)、 biliopancreatic diversion with duodenal switch(BPD-DS).At present,gastric bypass surgery and sleeve gastrectomy are still the most popular,laparoscopic minimally invasive operation was the main method.We performed laparoscopic gastric bypass(LRYGB)in 2010.This procedure has a good weight loss and hypoglycemic effect in obese patients with type 2 diabetes,especially to improve insulin resistance(HOMA-IR)in patients with T2 DM.It may be related to the changes of intestinal tract and intestinal hormone secretion after operation,and the specific mechanism needs to be further studied.In this study,50 obese patients with T2 DM were treated with LRYGB.The changes of clinical indexes such as body weight,blood glucose,blood lipids and some intestinal hormones datas were collected and compared before and after surgery.To observe the effect of LRYGB on obesity and T2 DM,and explore the possible mechanism of LRYGB to alleviate HOMA-IR.Objectives:To study the remission of insulin resistance(HOMA-IR)in type 2 diabetes mellitus after Laparoscopic Roux-en-Y gastric bypass surgery(LRYGB).Methods:The clinical data of 50 patients with T2 DM treated with LRYGB in the endoscopic ward of the first affiliated Hospital of Soochow University from June 2014 to June 2016 were collected and analyzed.Postoperative follow-up for one year.The status of glucose metabolism in all patients was evaluated before and one year after operation,and the treatment methods and onset time of diabetes were recorded.The data collection items included the basic informations of pre-operative patients and 3,6,12 months after surgery,including Body weight change index(BMI、WC、WHR),blood glucose change index(FPG)、FCPF、FInsn、Hb A1C),blood lipid metabolism index(TC、TG、HDL-C、LDL-C),Insulin resistance index(HOMA-IR、HOMA-β)and intestinal hormone index(GLP-1、GIP).The data were analyzed by SPSS 19.0 statistical software,the data were expressed as mean ±standard deviation,and compared before and after operation with matched sample t-test.HOMA-β,GLP-1,GIP expressed as M [P25P75],and compared with Mann-Whitney U test(P<0.05).There was statistical significance in comparing the data with Mann-Whitney U test(P<0.05).Results:All patients were successfully treated with LRYGB.The operative time was(142.1±33.9)minutes,and the intraoperative bleeding was(48.5±24.8)ml.Postoperative gastrointestinal anastomotic bleeding occurred in 2 cases,conservative treatment improved.One case developed marginal ulcer with bleeding 3 months after discharge,which was improved after acid suppression treatment.50 patients had high blood glucose with insulin resistance preoperation.At 3 months after surgery,body weight was(73.9±19.1)Kg,BMI was(32.9±6.0)Kg/m2,WC was(98.3±13.8)cm,WHR was(0.9±0.1),TC was(4.3±0.9)mmol/L,TG was(1.5±0.9)mmol/L,LDL-C was(2.6±0.7)mmol/L,FPG was(6.7±1.3)mmol/L,FCP was(2.2±1.1)ng/ml,FIns was(8.1±4.0)m IU/L,Hb A1 c was(6.5±0.8)%,HOMA-IR was(2.4±1.3),which were significantly lower than(86.8±23.4)Kg、(36.8±4.6)kg/m2、(106.7±14.7)cm、(1.0±0.2)、(4.9±1.2)mmol/L、(2.4±1.9)mmol/L、(3.0±1.0)mmol/L、(8.6±1.5)mmol/L、(3.0±1.7)ng/m L、(12.6±4.7)m IU/L、(8.9±2.2)%、(4.8±1.9)before operation,HDL-C was(1.4±0.3)mmol/L at 12 months postoperatively higher than preoperation(1.2+0.2)mmol/L(P<0.05).HOMA-β、GLP-1 was 62.0[30.9,108.0]、(3.10[2.25,4.05])pg/ml at 6 months after operation,which higher than 50.6[36.1,65.0]、(2.25[1.25,3.40])pg/ml before operation,GIP was(2.58[1.78,4.27])pg/ml,which was significantly lower than(4.16[1.54,12.46])pg/ml before operation(P<0.05).Conclusion:1.LRYGB is the main procedure for the treatment of obesity with T2 DM,The surgical trauma is small and safe;2.Obese patients with T2 DM were associated with high blood glucose,dyslipidemia and insulin resistance.The weight,blood glucose,blood lipid and insulin resistance of patients after LRYGB were significantly improved;3.The change of GLP-1 and GIP after LRYGB may be an effective mechanism for insulin resistance relief. |
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