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*Only for medical professionals to read for reference.
For patients with type 2 diabetes with high BMI and serious illness, metabolic surgery may be more effective than traditional medicine! On January 23, 2021, the "Lancet" published a clinical study of "10-year follow-up of an open, single-center, randomized controlled trial of metabolic surgical treatment and conventional treatment of diabetes", which broke the traditional treatment of type 2 diabetes.
pattern.
Among the 60 patients with severe type 2 diabetes who participated in the study, 15 of the 40 patients with type 2 diabetes who were treated with surgery were cured, and none of the 20 patients with type 2 diabetes who received medical treatment were cured.
1 Research background In order to scientifically evaluate and compare the advantages of metabolic surgery in the treatment of diabetes, and what is the effect, scientists led by Professor Geltrude Mingrone from Imperial College London carried out this research-using metabolic surgery and diabetes drugs to treat severe 2 Type 2 diabetes was followed up for 10 years.
After 10 years, we thoroughly evaluated the effects of the two treatments on patients with type 2 diabetes and evaluated the treatment effect.
2 Grouping of patients The conditions for participating in patients with severe type 2 diabetes are: the duration of type 2 diabetes history> 5 years, poor disease control, glycosylated hemoglobin HbA1c> 7.
0%, and body mass index ≥ 35kg/m2.
In the end, 60 patients were fully qualified for selection (Table 1), of which 28 were males and 32 were females, with an average age of 44 years.
The patients were randomly divided into groups 1:1:1 to receive medication, Roux-en-Y gastric shunt (RYGB) treatment (Figure 1), and cholangiopancreatic shunt (BPD) treatment (Figure 2).
Table 1 Grouping of patients and patient status Grouping status of drug treatment group, BPD group, RYGB group number (person) 202020 BMI (kg/m2) 44.
644.
444.
2 waist circumference (cm) 127139.
5129 diabetes history (year) 65.
56FGP (mmol/L) 9.
99.
79.
5HbA1c (%) 8.
58.
98.
6 Insulin resistance index 11.
07.
79.
7 Insulin usage (person) 11109 The two types of surgery used in the study for the treatment of type 2 diabetes are metabolic surgery developed in bariatric surgery for the treatment of obesity.
The national obesity and diabetes treatment guidelines and consensus recommend a mature and safe treatment.
Figure 1 Roux-en-Y gastrojejunal anastomosis; the stomach is divided into two parts, retaining the upper small gastric pouch, through which food enters the jejunum directly, bypassing most of the stomach, duodenum and part of the jejunum.
Figure 2 Biliary pancreatic duct shunt (BPD); sleeve gastrectomy is performed first, the stomach pylorus is preserved, and most of the small intestine is bypassed, causing absorption disorders.
3 Research results 2-5 years postoperatively.
In the first evaluation of treatment effect 2 years after metabolic surgery, none of the patients with type 2 diabetes in the drug treatment group met the criteria for diabetic remission; and gastric bypass (RYGB) 75% and 95% of patients in the biliary and pancreatic shunt (BPD) group met the criteria for diabetic remission, respectively.
At the 5-year follow-up after metabolic surgery, the proportions of patients in the gastric shunt (RYGB) and biliary-pancreatic shunt (BPD) groups were 37% and 63%, respectively (Figure 3).
Figure 3 Probability of remission brought by gastric bypass surgery (RYGB) and biliary-pancreatic bypass (BPD) 4 Research results 10 years after surgery (1) 34 participants with diabetes remission found at follow-up 2 years after metabolic surgery Among them, 20 patients (accounting for 58.
8% of the population whose diabetes had resolved during the 2-year follow-up after the operation) had recurrence of hyperglycemia during the subsequent follow-up.
Among them, the recurrence rate of the biliary-pancreatic bypass (BPD) group was 52.
6%; The recurrence rate in the bypass surgery (RYGB) group was 66.
7%. (2) Among the patients who did not remission in the first two years after the operation, there has been no remission and cure in the follow-up within 10 years, and the risk of recurrence of type 2 diabetes in the first 5 years after the operation is the highest.
(3) For patients undergoing gastric bypass surgery (RYGB), the median time to remission of diabetes was 5 years, and the median time to remission of diabetes for patients in the biliary-pancreatic bypass (BPD) group was 9 years.
(4) Patients with elevated blood sugar in the metabolic surgery treatment group (gastric bypass surgery group and biliary-pancreatic bypass surgery group) receive intensive insulin therapy and subsequent lifestyle intervention and/or drug therapy.
In the follow-up study, adequate blood glucose control was maintained, with an average HbA1c of 6.
7%.
The risk of diabetes complications was reduced by 93%, including adverse events in the heart, kidneys, and nervous system.
(5) The effect of metabolic surgery and drug therapy on body weight.
The patients with type 2 diabetes in the two metabolic surgery groups lost 30% of their body weight one year after the operation, and there was basically no significant change in their body weight during the follow-up period thereafter; while those in the drug treatment group The body weight of patients with type 2 diabetes decreased by an average of 4.
2% during the entire 10-year follow-up (Figure 4).
(6) The effect of metabolic surgery and drug treatment on glycosylated hemoglobin in the two metabolic surgery groups has been below 7%; in the drug group, glycosylated hemoglobin has a downward trend in the first 5 years, and HbA1c is close to 7%.
After 5 years, glycosylated hemoglobin gradually Elevated.
After 10 years, in the biliary-pancreatic shunt group and Roux-en-Y gastric shunt group, the average glycosylated hemoglobin of patients dropped to 6.
4% and 6.
7%, respectively, and the average glycosylated hemoglobin of patients in the drug treatment group was 7.
6% (Figure 4).
About half of the patients must use insulin at the beginning of the study.
After 10 years of the study, only 2.
5% of patients in the surgical group needed insulin therapy, while 53% of patients in the medical treatment group still needed insulin therapy.
Figure 4 The changes in blood glucose levels and weight of patients in the drug treatment (red line), gastric bypass surgery (RYGB, blue line) and biliary-pancreatic bypass (BPD, green line) group.
(7) Severe and obese type 2 diabetic patients are more willing to choose surgery; after 10 years of follow-up, no accidental risks related to surgery were found.
Compared with patients receiving medications, patients undergoing metabolic surgery lost more weight, used fewer medications, had lower cardiovascular risks, better quality of life, and a lower incidence of diabetes-related complications.
10 years after metabolic surgery, the follow-up rate was 95.
0%.
In the operation group, 15 patients with severe type 2 diabetes underwent a metabolic surgery to achieve a 10-year cure for diabetes.
Biliary pancreatic duct bypass (BPD) group completed 20 follow-ups, 10 were cured, and the cure rate was 50.
0%; Roux-en-Y gastric bypass (RYGB) group had a cure rate of 25.
0%, and 20 completed follow-ups , 5 cases were cured.
One case in the drug treatment group was cured, with a cure rate of 5.
5%.
Of the 20 patients who participated in the controlled study of drug therapy, 18 completed the follow-up and 1 cured.
However, this patient with type 2 diabetes who was cured by drugs was actually a patient who was found to be ineffective with drug treatment after the start of the study.
She crossed over to the surgical treatment group and received surgery in the middle of the treatment.
If this crossover operation is not counted In the case of cured patients, the actual diabetes cure rate in the medication group is 0%.
According to the latest definition of cure for type 2 diabetes published by the American Diabetes Association (ADA), a total of 15 patients with severe type 2 diabetes in the study reached the cure standard, and none in the drug treatment group reached the cure standard.
The conclusion of the study is: in the long-term control of type 2 diabetes, metabolic surgery is more effective than traditional medical treatment.
Clinicians and policy makers should ensure that metabolic surgery is appropriately considered in the management of obese and type 2 diabetes patients.
5 Significance of Metabolic Surgery in Cure Type 2 Diabetes This study uses sufficient clinical practice evidence to prove that compared with traditional drug therapy and lifestyle intervention, metabolic surgery can more effectively control and cure patients with severe type 2 diabetes for a long time.
The results of this trial will have a profound impact in the field of type 2 diabetes treatment, and even the most skeptical clinicians who are skeptical of surgical treatment of diabetes believe that metabolic surgery is part of the best treatment for patients with difficult-to-control type 2 diabetes.
——The two editorial authors of "The Lancet" This study provides the most powerful scientific evidence for "2 diabetes can be cured" so far, proving that adult type 2 diabetes does not necessarily require sexual development, nor is it irreversible disease.
——One of the researchers, Professor Francesco Rubino, MD, Chair of Weight Loss and Metabolic Surgery at King's College of Medicine, London.
These data confirm that metabolic surgery can be a cost-effective treatment for type 2 diabetes and should be regarded as severe type 2 The main treatment option for patients with diabetes and obesity.
——First author, Professor Geltrude Mingrone, King’s Medical College, London.
Compared with patients receiving medications, patients undergoing metabolic surgery lose more weight, use fewer medications, lower cardiovascular risks, better quality of life, and diabetes-related The incidence of complications is lower.
We now have 10 years of data showing that metabolic surgery is more effective than traditional medical treatment.
—— Alexander D.
Miras, Ph.
D.
from the Department of Metabolism, Digestion and Reproductive Studies, Imperial College London, and Carel le Roux, Ph.
D.
, from the Diabetes Complications Research Center, University of Dublin, Ireland.
References: [1] Geltrude Mingrone, et al.
, (2021).
Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomised controlled trial.
The Lancet, DOI:https://doi.
org/10.
1016/S0140-6736 (20)32649-0[2] Alexander D Miras, Carel W le Roux.
(2021).
Metabolic surgery versus conventional therapy in type 2 diabetes.
The Lancet, DOI: https://doi.
org/10.
1016/S0140-6736 (21)00129-X[3] Marlene Busko,(2021)Bariatric Surgery Gives 10-Year Cure for Some Advanced Diabetes.
Medscape Medical News #vp_2[4].
Endocrinology Branch of the Medical Association.
[Guide and Consensus] Expert Consensus on Comprehensive Management of Type 2 Diabetes and Obesity in China.
Chinese Journal of Endocrinology and Metabolism[J],2016,32(08): 623-627.
[5] Chinese Medical Association Surgery Branch Thyroid and Metabolic Surgery Group, Obesity and Diabetes Surgeons Committee of Surgeons Branch of Chinese Medical Doctor Association.
Guidelines for Surgical Treatment of Obesity and Type 2 Diabetes in China (2019 Edition)[J].
Chinese Journal of Practical Surgery,2019,39(4):301-306.
For patients with type 2 diabetes with high BMI and serious illness, metabolic surgery may be more effective than traditional medicine! On January 23, 2021, the "Lancet" published a clinical study of "10-year follow-up of an open, single-center, randomized controlled trial of metabolic surgical treatment and conventional treatment of diabetes", which broke the traditional treatment of type 2 diabetes.
pattern.
Among the 60 patients with severe type 2 diabetes who participated in the study, 15 of the 40 patients with type 2 diabetes who were treated with surgery were cured, and none of the 20 patients with type 2 diabetes who received medical treatment were cured.
1 Research background In order to scientifically evaluate and compare the advantages of metabolic surgery in the treatment of diabetes, and what is the effect, scientists led by Professor Geltrude Mingrone from Imperial College London carried out this research-using metabolic surgery and diabetes drugs to treat severe 2 Type 2 diabetes was followed up for 10 years.
After 10 years, we thoroughly evaluated the effects of the two treatments on patients with type 2 diabetes and evaluated the treatment effect.
2 Grouping of patients The conditions for participating in patients with severe type 2 diabetes are: the duration of type 2 diabetes history> 5 years, poor disease control, glycosylated hemoglobin HbA1c> 7.
0%, and body mass index ≥ 35kg/m2.
In the end, 60 patients were fully qualified for selection (Table 1), of which 28 were males and 32 were females, with an average age of 44 years.
The patients were randomly divided into groups 1:1:1 to receive medication, Roux-en-Y gastric shunt (RYGB) treatment (Figure 1), and cholangiopancreatic shunt (BPD) treatment (Figure 2).
Table 1 Grouping of patients and patient status Grouping status of drug treatment group, BPD group, RYGB group number (person) 202020 BMI (kg/m2) 44.
644.
444.
2 waist circumference (cm) 127139.
5129 diabetes history (year) 65.
56FGP (mmol/L) 9.
99.
79.
5HbA1c (%) 8.
58.
98.
6 Insulin resistance index 11.
07.
79.
7 Insulin usage (person) 11109 The two types of surgery used in the study for the treatment of type 2 diabetes are metabolic surgery developed in bariatric surgery for the treatment of obesity.
The national obesity and diabetes treatment guidelines and consensus recommend a mature and safe treatment.
Figure 1 Roux-en-Y gastrojejunal anastomosis; the stomach is divided into two parts, retaining the upper small gastric pouch, through which food enters the jejunum directly, bypassing most of the stomach, duodenum and part of the jejunum.
Figure 2 Biliary pancreatic duct shunt (BPD); sleeve gastrectomy is performed first, the stomach pylorus is preserved, and most of the small intestine is bypassed, causing absorption disorders.
3 Research results 2-5 years postoperatively.
In the first evaluation of treatment effect 2 years after metabolic surgery, none of the patients with type 2 diabetes in the drug treatment group met the criteria for diabetic remission; and gastric bypass (RYGB) 75% and 95% of patients in the biliary and pancreatic shunt (BPD) group met the criteria for diabetic remission, respectively.
At the 5-year follow-up after metabolic surgery, the proportions of patients in the gastric shunt (RYGB) and biliary-pancreatic shunt (BPD) groups were 37% and 63%, respectively (Figure 3).
Figure 3 Probability of remission brought by gastric bypass surgery (RYGB) and biliary-pancreatic bypass (BPD) 4 Research results 10 years after surgery (1) 34 participants with diabetes remission found at follow-up 2 years after metabolic surgery Among them, 20 patients (accounting for 58.
8% of the population whose diabetes had resolved during the 2-year follow-up after the operation) had recurrence of hyperglycemia during the subsequent follow-up.
Among them, the recurrence rate of the biliary-pancreatic bypass (BPD) group was 52.
6%; The recurrence rate in the bypass surgery (RYGB) group was 66.
7%. (2) Among the patients who did not remission in the first two years after the operation, there has been no remission and cure in the follow-up within 10 years, and the risk of recurrence of type 2 diabetes in the first 5 years after the operation is the highest.
(3) For patients undergoing gastric bypass surgery (RYGB), the median time to remission of diabetes was 5 years, and the median time to remission of diabetes for patients in the biliary-pancreatic bypass (BPD) group was 9 years.
(4) Patients with elevated blood sugar in the metabolic surgery treatment group (gastric bypass surgery group and biliary-pancreatic bypass surgery group) receive intensive insulin therapy and subsequent lifestyle intervention and/or drug therapy.
In the follow-up study, adequate blood glucose control was maintained, with an average HbA1c of 6.
7%.
The risk of diabetes complications was reduced by 93%, including adverse events in the heart, kidneys, and nervous system.
(5) The effect of metabolic surgery and drug therapy on body weight.
The patients with type 2 diabetes in the two metabolic surgery groups lost 30% of their body weight one year after the operation, and there was basically no significant change in their body weight during the follow-up period thereafter; while those in the drug treatment group The body weight of patients with type 2 diabetes decreased by an average of 4.
2% during the entire 10-year follow-up (Figure 4).
(6) The effect of metabolic surgery and drug treatment on glycosylated hemoglobin in the two metabolic surgery groups has been below 7%; in the drug group, glycosylated hemoglobin has a downward trend in the first 5 years, and HbA1c is close to 7%.
After 5 years, glycosylated hemoglobin gradually Elevated.
After 10 years, in the biliary-pancreatic shunt group and Roux-en-Y gastric shunt group, the average glycosylated hemoglobin of patients dropped to 6.
4% and 6.
7%, respectively, and the average glycosylated hemoglobin of patients in the drug treatment group was 7.
6% (Figure 4).
About half of the patients must use insulin at the beginning of the study.
After 10 years of the study, only 2.
5% of patients in the surgical group needed insulin therapy, while 53% of patients in the medical treatment group still needed insulin therapy.
Figure 4 The changes in blood glucose levels and weight of patients in the drug treatment (red line), gastric bypass surgery (RYGB, blue line) and biliary-pancreatic bypass (BPD, green line) group.
(7) Severe and obese type 2 diabetic patients are more willing to choose surgery; after 10 years of follow-up, no accidental risks related to surgery were found.
Compared with patients receiving medications, patients undergoing metabolic surgery lost more weight, used fewer medications, had lower cardiovascular risks, better quality of life, and a lower incidence of diabetes-related complications.
10 years after metabolic surgery, the follow-up rate was 95.
0%.
In the operation group, 15 patients with severe type 2 diabetes underwent a metabolic surgery to achieve a 10-year cure for diabetes.
Biliary pancreatic duct bypass (BPD) group completed 20 follow-ups, 10 were cured, and the cure rate was 50.
0%; Roux-en-Y gastric bypass (RYGB) group had a cure rate of 25.
0%, and 20 completed follow-ups , 5 cases were cured.
One case in the drug treatment group was cured, with a cure rate of 5.
5%.
Of the 20 patients who participated in the controlled study of drug therapy, 18 completed the follow-up and 1 cured.
However, this patient with type 2 diabetes who was cured by drugs was actually a patient who was found to be ineffective with drug treatment after the start of the study.
She crossed over to the surgical treatment group and received surgery in the middle of the treatment.
If this crossover operation is not counted In the case of cured patients, the actual diabetes cure rate in the medication group is 0%.
According to the latest definition of cure for type 2 diabetes published by the American Diabetes Association (ADA), a total of 15 patients with severe type 2 diabetes in the study reached the cure standard, and none in the drug treatment group reached the cure standard.
The conclusion of the study is: in the long-term control of type 2 diabetes, metabolic surgery is more effective than traditional medical treatment.
Clinicians and policy makers should ensure that metabolic surgery is appropriately considered in the management of obese and type 2 diabetes patients.
5 Significance of Metabolic Surgery in Cure Type 2 Diabetes This study uses sufficient clinical practice evidence to prove that compared with traditional drug therapy and lifestyle intervention, metabolic surgery can more effectively control and cure patients with severe type 2 diabetes for a long time.
The results of this trial will have a profound impact in the field of type 2 diabetes treatment, and even the most skeptical clinicians who are skeptical of surgical treatment of diabetes believe that metabolic surgery is part of the best treatment for patients with difficult-to-control type 2 diabetes.
——The two editorial authors of "The Lancet" This study provides the most powerful scientific evidence for "2 diabetes can be cured" so far, proving that adult type 2 diabetes does not necessarily require sexual development, nor is it irreversible disease.
——One of the researchers, Professor Francesco Rubino, MD, Chair of Weight Loss and Metabolic Surgery at King's College of Medicine, London.
These data confirm that metabolic surgery can be a cost-effective treatment for type 2 diabetes and should be regarded as severe type 2 The main treatment option for patients with diabetes and obesity.
——First author, Professor Geltrude Mingrone, King’s Medical College, London.
Compared with patients receiving medications, patients undergoing metabolic surgery lose more weight, use fewer medications, lower cardiovascular risks, better quality of life, and diabetes-related The incidence of complications is lower.
We now have 10 years of data showing that metabolic surgery is more effective than traditional medical treatment.
—— Alexander D.
Miras, Ph.
D.
from the Department of Metabolism, Digestion and Reproductive Studies, Imperial College London, and Carel le Roux, Ph.
D.
, from the Diabetes Complications Research Center, University of Dublin, Ireland.
References: [1] Geltrude Mingrone, et al.
, (2021).
Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomised controlled trial.
The Lancet, DOI:https://doi.
org/10.
1016/S0140-6736 (20)32649-0[2] Alexander D Miras, Carel W le Roux.
(2021).
Metabolic surgery versus conventional therapy in type 2 diabetes.
The Lancet, DOI: https://doi.
org/10.
1016/S0140-6736 (21)00129-X[3] Marlene Busko,(2021)Bariatric Surgery Gives 10-Year Cure for Some Advanced Diabetes.
Medscape Medical News #vp_2[4].
Endocrinology Branch of the Medical Association.
[Guide and Consensus] Expert Consensus on Comprehensive Management of Type 2 Diabetes and Obesity in China.
Chinese Journal of Endocrinology and Metabolism[J],2016,32(08): 623-627.
[5] Chinese Medical Association Surgery Branch Thyroid and Metabolic Surgery Group, Obesity and Diabetes Surgeons Committee of Surgeons Branch of Chinese Medical Doctor Association.
Guidelines for Surgical Treatment of Obesity and Type 2 Diabetes in China (2019 Edition)[J].
Chinese Journal of Practical Surgery,2019,39(4):301-306.
