GLYCEMIC BEHAVIOR IN 48 HOURS POSTOPERATIVE PERIOD OF PATIENTS WITH TYPE 2 DIABETES MELLITUS AND NON DIABETIC SUBMITTED TO BARIATRIC SURGERY

Although there is no indication for surgery taking only into account the glycemic condition, results have shown that benefits can be obtained in glycemic control with bariatric surgery. Aim : To compare the glycemic behavior among type 2 diabetic and non-diabetic patients within 48 h after bariatric surgery, and clarify whether there is a reduction in blood glucose level in obese patients with diabetes before the loss of weight excess. Methods : Descriptive epidemiological study with prospective cohort design with 31 obese patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy. The patients were controlled with hemoglucotests in different periods of time: preoperative, postoperative and each 6 h after surgery for 48 h. Results : Average ambulatory blood glucose in diabetics was 120.7±2.9 mg/dl vs 91.8±13.9 mg/dl in the nondiabetic. After 48 h there was decrease in diabetics to 100.0±17.0 mg/dl (p=0.003), while the non-diabetic group did not change significantly (102.7±25.4 mg/dl; p=0.097). There were no differences between the surgical techniques. There were no death. Conclusions : Diabetic patients significantly reduced blood glucose after surgery regardless of the use of exogenous insulin or oral hypoglycemic agents.

尽管仅以血糖状况作为手术适应证尚无明确依据，但已有研究结果显示，减重代谢手术（bariatric surgery）可在血糖控制方面获益。
研究目的：对比2型糖尿病患者与非糖尿病患者在减重代谢手术后48小时内的血糖变化情况，并明确肥胖糖尿病患者在体质量超额丢失前是否可出现血糖水平降低。
研究方法：本研究为采用前瞻性队列设计的描述性流行病学研究，共纳入31例行Roux-en-Y胃旁路术（Roux-en-Y gastric bypass）与袖状胃切除术（sleeve gastrectomy）的肥胖患者。研究于术前、术后即刻以及术后每6小时（持续监测48小时）多个时间点，使用指尖血糖检测仪（hemoglucotests）对患者进行血糖监测。
研究结果：糖尿病患者的平均动态血糖为120.7±2.9 mg/dl，非糖尿病患者为91.8±13.9 mg/dl。术后48小时，糖尿病患者的血糖降至100.0±17.0 mg/dl（p=0.003），而非糖尿病组血糖无显著变化（102.7±25.4 mg/dl；p=0.097）。两种手术术式间未观察到显著差异，且无患者死亡。
研究结论：无论是否使用外源性胰岛素（exogenous insulin）或口服降糖药物（oral hypoglycemic agents），糖尿病患者在术后血糖水平均出现显著降低。