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Abstract(s)
Estudos mostram que cirurgias bariátricas convencionais para o tratamento da obesidade mórbida, além de promoverem uma significativa e sustentada perda de peso, têm um impacto benéfico na remissão da diabetes mellitus tipo 2. Assim, este tipo de intervenções recebe actualmente a denominação de cirurgia metabólica.
Este trabalho propôs-se a acompanhar durante 2 anos a evolução dos doentes diabéticos sujeitos a cirurgia metabólica através da evolução do Índice de Massa Corporal (IMC), glicémia em jejum, Hemoglobina Glicosilada (HbA1c), taxas de remissão de diabetes e registo de complicações.
Foi analisada a base de dados de um centro clínico especializado - BaroClínica, Lisboa e foram identificados 119 doentes diabéticos submetidos a cirurgia metabólica pelo mesmo cirurgião. Da amostra, 106 pacientes tinham IMC ≥ 35 Kg/m2 e foram submetidos a: Gastrobandoplastia - GBP (n=67), mini-bypass gástrico (n=13), Bypass em Y de Roux – BPYR (n=21) e Sleeve Gástrico - SLG (n=5). Os 13 pacientes com IMC < 35 Kg/m2 foram submetidos a SLG (n=2) e a BPYR (n=11). A remissão de diabetes foi definida como interrupção ou ausência de medicação antidiabética com uma glicémia em jejum < 110 mg/dL e/ou HbA1c < 6,5 %. No final do follow-up, os pacientes com IMC ≥ 35 Kg/m2 submetidos a GBP, mini-bypass, BPYR e SLG apresentaram, respectivamente, diminuições do valor médio da glicémia em jejum (mg/dL) de 43,0±7,3; 60,3±19,9; 66,3±21,1 e 30,3±23,8 e taxas de remissão de 25,4%, 46,2%, 57,1% e 60%. Houve uma redução estatisticamente significativa da HbA1c nos três primeiros procedimentos. Ocorreu uma diminuição de peso sustentada em todos os subgrupos. A GBP teve uma taxa de complicações de 28,3% (19/67), maioritariamente por complicações pós-operatórias a longo prazo com necessidade de reoperação. Os pacientes com IMC < 35 Kg/m2 sujeitos a BPYR tiveram uma diminuição média do valor de glicémia em jejum de 51,3±21,8 mg/dL, da HbA1c de 1,2%±1,0 (p<0,05) e uma taxa de remissão de 63,6%.
Concluiu-se neste estudo que a cirurgia metabólica é uma abordagem eficaz e segura no controlo da diabetes mellitus tipo 2, que o melhor resultado é apresentado pelas cirurgias de bypass e pelo SLG e que não há diferença na evolução clínica entre doentes com IMC ≥ e < 35 Kg/m2.
Several studies showed that conventional bariatric operations for the treatment of morbid obesity promote a significant and sustained weight loss and have a beneficial impact on the remission of type 2 diabetes mellitus. These procedures are now called as metabolic surgery. The aim of this study was to access two-year evolution of diabetic patients who underwent metabolic surgery, through values of Body Mass Index (BMI), fasting glucose, Glycated Hemoglobin (HbA1c), diabetes remission and complication rates. Based on data from a specialized clinical center – BaroClínica, Lisbon, we identified 119 patients with type 2 diabetes mellitus who underwent metabolic surgery performed by the same surgeon. Among the patients, 106 had BMI ≥ 35 Kg/m2 and were submitted to: gastric banding (n=67), minigastric bypass (n=13), Roux-en-Y Bypass - RYBP (n=21) and Sleeve Gastrectomy - SG (n=5). The 13 patients with BMI < 35 Kg/m2 underwent SG (n=2) and RYBP (n=11). Remission of diabetes was defined as patients not requiring hypoglycemic medication with values of fasting glucose below 110mg/dL and/or HbA1c < 6,5%. Among patients with BMI ≥ 35 Kg/m2 who underwent gastric banding, mini- -gastric bypass, RYBP and SG, fasting glucose (mg/dL) decreased 43,0±7,3; 60,3±19,9; 66,3±21,1; 30,3±23,8, respectively, and 25,4%, 46,2%, 57,1%, 60% fulfilled the definition of remission at the latest follow-up. There was a statistically significant reduction in HbA1c in the first three procedures. Sustained weight loss occurred in all surgical procedures. Gastric banding had a complication rate of 28,3% (19/67), mainly postoperative complications requiring reoperation. Patients with BMI < 35 Kg/m2 undergoing RYBP had a fasting glucose mean decrease of 51,3±21,8 and HbA1c mean decrease of 1,2%±1,0 (p<0,05). Remission was achieved in 63,6% of patients. In summary, metabolic surgery is a safe and effective approach in type 2 diabetes mellitus control. The best results were shown with bypass surgery and sleeve gastrectomy. There was no clinical difference between patients with BMI ≥ and < 35 Kg/m2.
Several studies showed that conventional bariatric operations for the treatment of morbid obesity promote a significant and sustained weight loss and have a beneficial impact on the remission of type 2 diabetes mellitus. These procedures are now called as metabolic surgery. The aim of this study was to access two-year evolution of diabetic patients who underwent metabolic surgery, through values of Body Mass Index (BMI), fasting glucose, Glycated Hemoglobin (HbA1c), diabetes remission and complication rates. Based on data from a specialized clinical center – BaroClínica, Lisbon, we identified 119 patients with type 2 diabetes mellitus who underwent metabolic surgery performed by the same surgeon. Among the patients, 106 had BMI ≥ 35 Kg/m2 and were submitted to: gastric banding (n=67), minigastric bypass (n=13), Roux-en-Y Bypass - RYBP (n=21) and Sleeve Gastrectomy - SG (n=5). The 13 patients with BMI < 35 Kg/m2 underwent SG (n=2) and RYBP (n=11). Remission of diabetes was defined as patients not requiring hypoglycemic medication with values of fasting glucose below 110mg/dL and/or HbA1c < 6,5%. Among patients with BMI ≥ 35 Kg/m2 who underwent gastric banding, mini- -gastric bypass, RYBP and SG, fasting glucose (mg/dL) decreased 43,0±7,3; 60,3±19,9; 66,3±21,1; 30,3±23,8, respectively, and 25,4%, 46,2%, 57,1%, 60% fulfilled the definition of remission at the latest follow-up. There was a statistically significant reduction in HbA1c in the first three procedures. Sustained weight loss occurred in all surgical procedures. Gastric banding had a complication rate of 28,3% (19/67), mainly postoperative complications requiring reoperation. Patients with BMI < 35 Kg/m2 undergoing RYBP had a fasting glucose mean decrease of 51,3±21,8 and HbA1c mean decrease of 1,2%±1,0 (p<0,05). Remission was achieved in 63,6% of patients. In summary, metabolic surgery is a safe and effective approach in type 2 diabetes mellitus control. The best results were shown with bypass surgery and sleeve gastrectomy. There was no clinical difference between patients with BMI ≥ and < 35 Kg/m2.
Description
Keywords
Diabetes mellitus tipo 2 Diabetes mellitus tipo 2 - Cirurgia metabólica Cirurgia bariátrica Bypass em y de Roux Sleeve gástrico
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Citation
Publisher
Universidade da Beira Interior