Outcomes in glycemic control in the intermediate follow-up of Roux-en-Y gastric bypass: a Brazilian cohort study.

Autor:	Beleigoli AM; Departamento de Clínica Médica; Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil., Coelho AL; Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil., Diniz MT; Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil; Departamento de Cirurgia; Instituto Alfa de Gastroenterologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Brasil., Lages Savassi-Rocha A; Instituto Alfa de Gastroenterologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Brasil., Diniz Mde F; Departamento de Clínica Médica; Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil; Serviço de Endocrinologia e Metabologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Brasil. Electronic address: mfhsdiniz@yahoo.com.br.
Jazyk:	angličtina
Zdroj:	Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery [Surg Obes Relat Dis] 2014 Nov-Dec; Vol. 10 (6), pp. 1022-7. Date of Electronic Publication: 2014 Sep 06.
DOI:	10.1016/j.soard.2014.08.016
Abstrakt:	Background: It is not widely known whether glycemic control (GC) is sustained after Roux-en-Y gastric bypass (RYGB). The objective of this study was to investigate incidence and remission of type 2 diabetes mellitus (T2DM) among 284 individuals with body mass index (BMI)≥35 kg/m(2) at operation (1998-2011) through 2013. Methods: Baseline GC was based on fasting glycemia (FG), hemoglobin A1c (HbA1c), and medication. Incident T2DM, complete (normal GC/HbA1c) and partial (abnormal FG/A1c) remission at the last follow-up visit, and relapse were the outcomes of interest. Kaplan-Meier curves and log-rank tests were used to compare time to improvement according to insulin use and HbA1c levels at baseline. Pre- and postoperative determinants of T2DM improvement were investigated by logistic regression. Results: Participants were predominantly female (220; 77.2%) with mean age of 39.6 (10.5) years and median BMI of 51.9 (46.1-57.5) kg/m(2) at operation. The mean follow-up time was 5.1 (3.2) years with 67.5% (55.0-78.4) of excess BMI loss (EBL) at the 5(th) year. Normal GC, abnormal FG, and T2DM were observed in 169 (59.5%), 32 (11.2%), and 83 (29.3%) participants at baseline, respectively. The 7 (4.1%) patients with incident T2DM had lower BMI at baseline than those who remained with normal GC (43.6 kg/m(2) [42.0-50.8] versus 52.1 kg/m(2) [46.7-57.7]; P = .01). Complete and partial T2DM remission occurred in 61 (61.3%) and 5 (6.7%) participants, respectively. Baseline HbA1c was associated with a significant difference in the proportion of cases with remission at the 5(th) year of follow-up (P = .016). Age (OR .83; 95% CI .72-.95) and % EBL at the 2(nd) year of follow-up (OR 1.05; 95% CI 1.01-1.09) were independent determinants of T2DM improvement. Relapse occurred in 14 (14.3%) cases. Conclusion: We observed a low incidence and impressive improvement rates of T2DM after intermediate follow-up of RYGB. (Copyright © 2014 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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