| 【Objective】To observe the effect of laparoscopic gastric bypass on islet β-cell function in patients with type 2 diabetes and its therapeutic effect on obesity and its comorbidities【Method】Data of 20 patients with obesity and type 2 diabetes who underwent laparoscopic gastric bypass surgery(LRYGB)in the Second People’s Hospital of Qujing City from July 2017 to July 2020 were collected for this study.Before and after surgery,body weight,body mass index(BMI),excess weight loss%(EWI%),fasting plasma glucose(FPG),2-hour postprandial plasma glucose(2h PG),and total cholesterol(TC),total triglycerides(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),hemoglobin(Hb A1c),oral glucose tolerance test(OGTT)were recorded.Homeostasis model assessment of insulin resistance index(HOMA-IR)and Matsuda index were calculated to evaluate insulin resistance.Homeostasis model assessment of β cell function(HOMA-β)and OGTT insulin area under the curve were calculated.AUC)and the ratio of the glucose area under curve(AUC insulin /AUC glucose),early phase insulin secretion(Δ I30 min / Δ G30min),the secretion of insulin sensitive index-2(insulin secretion-sensitivity index 2,ISSI-2)to assess the function of islet β cells.To evaluate the effect of LRYGB on islet β-cell function by comparing the changes of various indexes before and after surgery.【Results】All operations were performed under laparoscopy by the same surgical team,and there was no conversion to open surgery or death.One patient developed pulmonary infection after the operation,and was discharged after symptomatic treatment such as antiinfection.Postoperative follow-up showed that there were 2 patients with dumping syndrome,advised to eat less and more meals,avoid too sweet,too strong food,symptoms improved.One patient developed anastomotic ulcer,and the symptoms were relieved after acid-fast and stomach-preserving treatment.No anastomotic fistula,gastric bleeding,gastroparesis,abdominal infection and other serious complications occurred in all patients.Six months after surgery,the patient’s body weight(kg)and BMI(kg/m2)were significantly decreased [(89.31±18.3)vs.(68.53±11.63)(P<0.01)] and [(32.63±5.39)vs.(25.11±3.62)(P<0.01)].EWI% was(85.15±28.01)% 6 months after operation.In patients with dyslipidemia,TG,TC and LDL-C were significantly decreased [(4.13±3.0)vs.(1.59±0.57)(P<0.01),(5.33±2.06)vs.(4.2±0.93)(P<0.01),(2.84±0.89)vs.(2.03±0.86)(P<0.05)],and HDL-C was significantly increased [(0.98±0.40)vs.(1.17±0.22)(P<0.05)].Six months after surgery,the effective rate of T2 DM was 100%,the remission rate was 80%(16/20),and the complete remission rate was 40%(8/20).The difference of FPG(mmol/L),2h PG(mmol/L)and Hb A1c(%)6 months after operation was statistically significant compared with that before operation [(11.47±3.35)vs.(6.23±1.18)(P<0.01),(20.38±3.92)vs.(8.33±3.75)(P<0.01),(9.17±1.3)vs.(6.15±1.20)(P<0.01)].After operation,HOMA-IR decreased significantly [(8.34±4.57)vs.(2.93±1.37)(P<0.01)],and Matsuda index increased significantly [(35.87±13.15)vs.(72.66±38.56)(P<0.05)].Postoperative pancreatic islet beta cell function indicators such as HOMA-β,AUC insulin /AUC glucose,ISSI-2,Δ I30 min / Δ G30 Min was significantly increased [(50.03±36.50)vs.(105.35±95.90)(P<0.05),(2.46±1.59)vs.(6.59±6.07)(P<0.05),(80.89±49.66)vs.(344.38±198.25)(P<0.05),(3.7±3.33)vs.(9.05±10.27)(P<0.05)].In addition,the patient’s other comorbidities,such as hypertension,fatty liver,and sleep apnea,were significantly improved.【Conclusion】LRYGB surgery is a safe and effective method for weight loss.While treating obesity,it can significantly improve the function of pancreatic β cells and alleviate insulin resistance in patients,thus achieving the effect of treating diabetes. |
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