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腹腔鏡袖狀胃切除術治療2型糖尿病患者糖尿病緩解的預測因子：一項前瞻性研究：一年隨訪
Other Title
Predictors of Type 2 Diabetes Mellitus Remission After Laparoscopic Sleeve Gastrectomy: one-year follow-up
Type
thesis
Date Issued
2018-06-29
Author(s)
阮氏金銀
Advisor
王偉
Subjects
系所名稱：國際醫學研究碩士學位學程
Description
學位別：碩士
語文別：英文
指導教授：王偉
口試委員：黃銘德;劉燦宏
中文關鍵字：Laparoscopic sleeve gastrectomy, obesity, type 2 diabetes mellitus, diabetic remission
英文關鍵字：Laparoscopic sleeve gastrectomy, obesity, type 2 diabetes mellitus, diabetic remission
語文別：英文
指導教授：王偉
口試委員：黃銘德;劉燦宏
中文關鍵字：Laparoscopic sleeve gastrectomy, obesity, type 2 diabetes mellitus, diabetic remission
英文關鍵字：Laparoscopic sleeve gastrectomy, obesity, type 2 diabetes mellitus, diabetic remission
Abstract
Background: Obesity and type 2 diabetes mellitus (T2DM) have become increasingly pandemic diseases in the world and developed at younger age and more severe in Asia population. LSG has been increasing in Asia. We investigated the diabetic remission and the possible preoperative predictors by using the latest Standards of Medical Care in Diabetes - 2017 of American Diabetes Association.
Materials and methods: We selected overweight and obesity patients who firstly received T2DM undergoing LSG from 2014 to 2016 in Taipei Medical Hospital. The complete diabetic remission was defined as glycated hemoglobin (HbA1c) < 5.7% or fasting blood glucose (FBG) < 100mg/dL and partial diabetic remission with HbA1c within 5.7-6.4% and FBG from 100 to 125 mg/dL within one year without medication therapy or ongoing procedures. Changes of body composition and biomarkers were evaluated as preoperative predictors of diabetic remission at 6th an 12th month. Multivariate analysis was used to determine preoperative predictors of diabetic remission at each time-point.
Results: Of 189 patients (55% female) who underwent LSG with mean of body mass index (41.3 ± 6.8kg/m2 ) and mean of age (42.3 9.7 yrs). All patients experienced weight loss significantly at 6th and 12th month after bariatric/metabolic surgery. Totally, LSG showed benefits via two-third of patients achieving diabetic remission six months after surgery. LSG significantly reduced body composition consisting of waist, hip circumference, fat mass percentage, body metabolic rate and increased percentage of muscle mass from six-month after surgery. FBG and HbA1c were improved significantly during one-year follow-up. In addition, LSG ameliorated kidney function, lipid profile at 6th month but lipid profile was elevated after 12-month surgery. Patients 40 years old, HbA1c < 9%, C-peptide 5 ng/ml and C-reactive protein (CRP) 0.5 mg/dl were considered as predictors of diabetic remissions.
Conclusion: Age, diabetic stages, -cell function, CRP levels are considered to be the predictors for achieving diabetic remission after sleeve gastrectomy in Taiwan population.
Keywords: Laparoscopic sleeve gastrectomy, obesity, type 2 diabetes mellitus, diabetic remission
Materials and methods: We selected overweight and obesity patients who firstly received T2DM undergoing LSG from 2014 to 2016 in Taipei Medical Hospital. The complete diabetic remission was defined as glycated hemoglobin (HbA1c) < 5.7% or fasting blood glucose (FBG) < 100mg/dL and partial diabetic remission with HbA1c within 5.7-6.4% and FBG from 100 to 125 mg/dL within one year without medication therapy or ongoing procedures. Changes of body composition and biomarkers were evaluated as preoperative predictors of diabetic remission at 6th an 12th month. Multivariate analysis was used to determine preoperative predictors of diabetic remission at each time-point.
Results: Of 189 patients (55% female) who underwent LSG with mean of body mass index (41.3 ± 6.8kg/m2 ) and mean of age (42.3 9.7 yrs). All patients experienced weight loss significantly at 6th and 12th month after bariatric/metabolic surgery. Totally, LSG showed benefits via two-third of patients achieving diabetic remission six months after surgery. LSG significantly reduced body composition consisting of waist, hip circumference, fat mass percentage, body metabolic rate and increased percentage of muscle mass from six-month after surgery. FBG and HbA1c were improved significantly during one-year follow-up. In addition, LSG ameliorated kidney function, lipid profile at 6th month but lipid profile was elevated after 12-month surgery. Patients 40 years old, HbA1c < 9%, C-peptide 5 ng/ml and C-reactive protein (CRP) 0.5 mg/dl were considered as predictors of diabetic remissions.
Conclusion: Age, diabetic stages, -cell function, CRP levels are considered to be the predictors for achieving diabetic remission after sleeve gastrectomy in Taiwan population.
Keywords: Laparoscopic sleeve gastrectomy, obesity, type 2 diabetes mellitus, diabetic remission