Two-year Efficacy Analysis Of Laparoscopic Metabolic Surgery In Obese Type 2 Diabetes Mellitus

Background:Globally,the incidence of obesity and type 2 diabetes millitus(T2DM)is increasing year by year,and it has become a global health problem,posing a great threat to public health[1].Traditional treatments do not achieve satisfactory long-term therapeutic effects.As an emerging approach,the efficacy of weight loss metabolic surgery in improving obesity and type 2 diabetes has been recognized by a growing number of countries and international organizations.At present,in the field of obesity and type 2 diabetes,China's related research focuses on the efficacy within one year after surgery,and there are few studies on the effect of two years or even longer after surgeryAim:To analyze the 2-year efficacy of Laparoscopic metabolic surgery for obese type 2 diabetes,and to observe whether there is any difference in the efficacy of Laparoscopic Roux-en-Y Gastric Bypass(LRYGB)and Laparoscopic Sleeve Gastrectomy(LSG)Method:Fourteen patients with Obese type 2 diabetes mellitus who underwent LRYGB or LSG at the First Affiliated Hospital of Da Lian Medical University from April 2015 to April 2016 were included in this study.The clinical data of patients before and 2 years after surgery were collected,including age(A),height(H),weight(W),waist Circumference(WC),fasting plasma glucose(FPG),2 hours postprandial plasma glucose(2hPG),fasting C peptide(CP),2-hour C-peptide(2hCP),glycated hemoglobin(HbAlc%),lipid metabolism index,liver enzyme index,renal function index,hemoglobin.The body mass index,HOMA-IR,HOMA-?the ratio of 2-hour C-peptide to fasting C-peptide(C2/CO),the percentage of extra weight loss(%EWL)and the percentage of extra BMI loss(%EBMIL)were calculated before and 2 years after surgery,respectively,and the use of drugs after surgery was recorded.The clinical efficacy and complications 2 years after surgery were observed.The patients were divided into two groups according to the surgical procedure,compare the difference between LSG and LRYGBResults:1.Two years after the metabolic surgery,10 of the 14 patients had remission of diabetes mellitus(6 complete remission,4 partial remission,71.5%),3 diabetes improvement(21.4%),and 1 case ineffective(7.1%).The remission rate of LRYGB group was 60%,the effective rate was 90%(9 cases)and that of LSG group was 100%(4 cases).There was no significant difference between the two groups(P=0.370)Among the effective patients,1 case still needed to use hypoglycemic drugs,while the other 12 cases(86.7%)did not use hypoglycemic drugs.Two years after surgery,the overall incidence of adverse reactions was 35.7%(5 cases),and there was no significant difference between the two groups(P=1.000)2.Two years after surgery,W(kg),WC(cm),BMI(kg/m2)were significantly lower than before surgery[88.89±9.86 VS 70.04±10.20(P=0.000),103.46±13.24 VS 88.64±6.04,(P=0.004),30.62±2.77 VS 23.72±3.02(P=0.000)respectively].FPG(mmol/L),2hPG(mmol/L),HbAlc(%),HOMA-IR were significantly improved compared with preoperative[9.40±4.16 VS 6.00±2.25(P=0.002),18.10±6.00 VS 9.77±,respectively).5.24(P=0.006),8.30±1.85 VS 6.59±1.31(P=0.003),3.35(2.84,4.68)VS 2.10(1.20,2.52)(P=0.005)].C2/C0 increased from 2.29±0.82 to 4.66±2.70,which was significantly improved compared with preoperative(P=0.020)HOMA-? had no significant change compared with preoperative(P=0.071)?3.Two years after surgery,triglyceride(TG),serum albumin(Alb)and ?-glutamyl transferase(?-GT)were significantly improved compared with preoperative[2.05±1.04 VS 1.19±0.63(P=0.007).42.39±2.33 VS 44.22±2.47(P=0.023),33.00(22.00,45.00)VS 14.00(13.00,19.00)(P=0.001)].Total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),aspartate aminotransferase(AST),alanine aminotransferase(ALT),phosphatase(ALP),serum uric acid(UA)and creatinine(Cre)had no significant change compared with preoperative(P>0.05).Hb decreased compared with preoperative(P=0.030)4.There were no significant differences between the LRYGB group and the LSG group in preoperative indexes and two years after surgery(P>0.05)Conclusion:1.Two years after laparoscopic metabolic surgery,patients with type 2 diabetes mellitus achieved good blood glucose control,reduced insulin resistance and improved islet function while losing weight2.Triglyceride metabolism was improved in type 2 diabetes mellitus patients 2 years after laparoscopic metabolic surgery,but serum uric acid level remained unchanged.