SAN DIEGO (EGMN) – Adults with diabetes who underwent Roux-en-Y gastric bypass surgery achieved significantly better improved insulin sensitivity and more rapid weight loss, compared with those who were on a low-calorie diet, results from 14-patient, single-center study showed.

“What we found is that there is a much greater improvement after the bypass procedure in terms of the way the body deals with glucose and the way the body makes insulin, compared to the people who lost the same amount of weight by diet,” Dr. Judith Korner, lead study investigator, said during a press briefing at the annual meeting of the Endocrine Society. “What this is telling us is, independent of all this hormone secretion that occurs with a meal, if you even just inject your body with glucose, after the bypass you’re much more able to deal with blood sugar.”

Dr. Korner, of the division of endocrinology in the department of medicine at Columbia University’s College of Physicians and Surgeons, New York, was quick to point out that the study involved 14 adults who underwent a strict protocol, “so I don’t want to say that the bypass is definitely better for the treatment of diabetes than diet. The reason I say that is, the people who were on the diet lost weight much slower. It took 8 weeks for those on the diet to lose weight as opposed to 3. 5 weeks for those on the bypass.”

In the study, funded by the U.S. National Institute of Diabetes and Digestive and Kidney Diseases, she and her associates assigned seven obese patients with type 2 diabetes to receive an 800-calorie liquid diet and no surgery, and seven to undergo gastric bypass surgery. The researchers performed an insulin-supplemented intravenous glucose tolerance test before and after each patient achieved an average weight loss of 8%, which marked the end of the study. Analyses included glucose effectiveness, insulin sensitivity, and insulin secretion normalized to the degree of insulin resistance.

The average age of patients was 50 years.

While glucose effectiveness did not change significantly in either group, insulin sensitivity increased significantly in the surgery group (from 1.22 to 1.86 mU/L) but not in the low-calorie diet group (from 1.38 to 1.80 mU/L). Beta cell function (DI, the amount of insulin secreted by the pancreas relative to the level of insulin sensitivity) improved significantly in both groups, but improvement was significantly greater in the surgery group (258.2 vs. 55.9).

It took patients in the surgery group about 3.5 weeks to shed 8% of their body weight, compared with about 8 weeks for those in the low-calorie diet group, a difference that was statistically significant.

Dr. Korner said that gastric bypass works so well because it allows patients “to eat very few calories – even less than 800 calories a day. That’s very difficult to do without surgical manipulation. The other thing [about gastric bypass] is that it changes the secretion of hormones so that you favor insulin secretion and insulin sensitivity. The people in the bypass group were off of all [diabetes] medications at the end of treatment, whereas the people in the diet group reduced their medications by about 55%.

“I think what we have to do is try to continue to study the bypass patients to see if we can mimic those changes that increase satiety and decrease hunger, to see if we can do that with people who are on low-calorie diet.”

Dr. Korner disclosed that she has received research funding for an unrelated study from Covidien.

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圣地亚哥 (EGMN)——一项入选14例糖尿病成人患者的单中心研究显示，与低热量饮食相比，Roux-en - Y胃旁路术可更显著改善胰岛素敏感性及更快降低体重。

 

主要研究者Judith Korner博士在内分泌学会年会的新闻发布会上说：“我们发现，与通过低热量饮食降低相同体重的患者相比，进行旁路术的患者在血糖代谢和胰岛素分泌方面获得的改善明显更大。这表明，独立于餐时胰岛素分泌，在旁路术后即使对患者单纯注射葡萄糖，也能够明显更好地管理血糖。”

 

纽约哥伦比亚大学内科医师与外科医师学院医学系内分泌科的Korner博士同时指出，该研究入选了14例严格遵守研究方案的成人患者，“因此，我不想说，旁路术治疗糖尿病的效果明确优于饮食。我之所以这样说，是由于饮食组患者的体重降低更为缓慢。饮食组8周后才观察到体重降低，而旁路术组3.5周后就观察到这一现象。

 

在这项由美国国立糖尿病、消化及肾疾病研究所资助的研究中，7例2型糖尿病肥胖患者接受饮食(800热量流质饮食)干预，另7例进行胃旁路术。研究者在每例患者达到体重平均降低8%这一标志研究结束的目标之前和之后对其进行补充胰岛素的静脉葡萄糖耐量试验。对葡萄糖效能、胰岛素敏感性和恢复至胰岛素抵抗水平的胰岛素分泌进行分析。

 

患者的平均年龄为50岁。

 

两组的葡萄糖效能均未出现显著改变。手术组的胰岛素敏感性从1.22 mU/L显著增至1.86 mU/L，但低热量饮食组的胰岛素敏感性增加不显著( 从1.38 mU/L增至 1.80 mU/L)。 两组的β细胞功能(相对于胰岛素敏感水平的胰腺胰岛素分泌量)均显著改善，但手术组改善明显更大(258.2对55.9)。

 

低热量饮食组花了8周的时间才达到体重降低8%的目标，而手术组患者花了约3.5周，差异具有统计学意义。

 

Korner博士表示，胃旁路术效果如此好是因为其使得患者“每天摄入非常少的热量——甚至低于800卡路里。如未做手术的话，是很难达到这点的。胃旁路术的另一个优点还在于其可改变激素分泌，增加胰岛素分泌量和胰岛素敏感性。胃旁路术组患者在研究结束时均停掉了所有糖尿病药物，而饮食组患者服用的药物减少了约55%。

 

 “我认为，我们应继续对旁路术患者进行研究，以探讨我们是否能够模拟那些增加饱腹感和减少饥饿感的改变，以及是否能够使低热量饮食患者发生这些改变。”

 

Korner博士声明其所进行的另一项研究获得Covidien公司的资助。

 

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