Obez tip 2 diyabetik hastalarda bariatrik cerrahi ve eksenatid tedavisinin laboratuar ve klinik parametreler üzerine etkilerinin karşılaştırmalı olarak değerlendirilmesi
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Date
2016
Authors
Elbasan, Onur
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Publisher
Uludağ Üniversitesi
Abstract
Obezite ve diyabet, tüm dünyada gittikçe artan, önemli bir morbidite ve mortalite nedenidir. Obezite tip 2 diyabetik hastalar için majör risk faktörü olup, tip 2 diyabetik hastaların tedavisinde kilo kaybı önemli yer tutar. Literatürde obez tip 2 diyabetik hastalarda medikal ve cerrahi tedavinin etkinliğinin kıyaslandığı birçok çalışma bulunmaktadır. Biz de çalışmamızda obez diyabetik hastalarda ülkemizde kullanımı yaygınlaşan GLP(glucagon-like peptide)-1 agonistlerinden olan eksenatid ve seçilmiş vakalarda uygulanan cerrahi yöntemlerden biri olan laparoskopik sleeve gastrektominin (LSG) laboratuvar ve klinik parametreleri üzerindeki etkisini araştırmayı ve karşılaştırmayı amaçladık. Bu amaçla 1 Ocak 2011-1 Aralık 2015 tarihleri arasında, Uludağ Üniversitesi Tıp Fakültesi Endokrinoloji ve Metabolizma Hastalıkları Bilim Dalı'na başvuran diyabetik morbid obez olgu dosyaları retrospektif olarak taranarak bariyatrik cerrahi uygulanmış 25 hasta ve eksenatid tedavisi başlanmış 25 hasta çalışmaya dahil edildi. Hastaların yaş, cinsiyet, antidiyabetik ilaç kullanımı, yandaş hastalıkları,boy, kilo, beden kitle indeksi (BKİ), sistolik kan basıncı (SKB), diyastolik kan basıncı (DKB), açlık kan şekeri (AKŞ), tokluk kan şekeri (TKŞ), hemoglobin A1c (HbA1c), üre, kreatinin, aspartat aminotransferaz (AST), alanin aminotransferaz (ALT), düşük dansiteli lipoprotein (low density lipoprotein: LDL) kolesterol, yüksek dansiteli lipoprotein (high density lipoprotein: HDL) kolesterol, trigliserid (TG), total kolesterol (TK), tiroid stimülan hormon (TSH), spot idrarda glukoz ve protein parametreleri incelendi. Eksenatid ve LSG gruplarında tedavinin 6. ayında kilo ve BKİ'de anlamlı azalma tespit edilmekle birlikte, LSG grubundaki azalma anlamlı olarak daha yüksek saptandı. Altı aylık takip sonunda, cerrahi grubunda kilo kaybı yaklaşık 35,4 kg iken eksenatid grubunda 11,5 kg olarak bulundu. Her iki grupta TKŞ ve HbA1c'de anlamlı azalma saptanırken, LSG grubundaki azalma eksenatid grubuna kıyasla anlamlı olarak yüksek saptandı. Eksenatid grubunda AKŞ'de anlamlı değişiklik izlenmezken, LSG grubunda AKŞ'de anlamlı azalma görüldü. Her iki grupta SKB ve DKB'de tedavinin 6. ayında anlamlı azalma görülürken, gruplar arasında anlamlı farklılık saptanmadı. Eksenatid tedavisi ile başlangıca göre 6. ayda insülin kullanan hasta sayısı ve yüzdesinde anlamlı değişim olmazken, hastaların kullandığı total insülin dozunda anlamlı olarak azalma saptandı. LSG grubunda ise insülin kullanan hasta sayısında anlamlı azalma görülürken, toplam insülin dozunda anlamlı değişiklik saptanmadı. LSG'nin 6. ayında TG'de anlamlı azalma görülürken, LDL ve TK'de ise anlamlı değişim saptanmadı. HDL'de ise anlamlı artış mevcuttu. Eksenatid grubunda lipid profilinde anlamlı değişim olmadı. Bariyatrik cerrahi sonrası 6. ayda başlangıca kıyasla spot idrarda protein saptanan hasta sayısında anlamlı azalma olduğu tespit edilirken, eksenatid grubunda anlamlı değişiklik olmadı. Cinsiyetler arası farklılık incelendiğinde eksenatid kullanan erkeklerde SKB'deki azalmanın daha fazlaolması haricinde parametrelerin değişim yüzdeleri açısından cinsiyetler arası fark olmadığı görüldü. LSG yapılan hastalarda da klinik ve laboratuvar parametrelerin değişimi açısından cinsiyetler arası anlamlı farklılık saptanmadı. Sonuç olarak, diyabetik obezlerde LSG endikasyon dahilinde uygulanması gereken, eksenatid kullanımına göre daha radikal bir yöntem olup obezite ilişkili diyabetik ve metabolik parametreleri daha etkin düzelten bir uygulama olarak görünmektedir. Ancak eksenatidin de obezite ilişkili diyabet ve metabolik parametreler üzerine olumlu etkileri olduğu çalışmamızın sonuçlarında ortaya konulmuştur. Her iki tedavi şekli de her hasta için avantaj ve dezavantajları yönünden değerlendirilmeli, her hasta için uygun tedavi seçeneğine hasta özelliklerine göre karar verilmelidir.
Obesity and diabetes are major causes of morbidity and mortality that are increasing all over the world. As obesity is a major risk factor for type 2 diabetic patients, weight loss has an important place in the treatment of type 2 diabetic patients. There are many studies in the literature comparing the effectiveness of medical and surgical treatmentsin obese type 2 diabetic patients. In our study, we aimed to evaluate and compare the effects of exenatide which is a glucagon-like peptide-1 (GLP1) agonist having an increasing usage in obese diabetic patients and laparoscopic sleeve gastrectomy (LSG) being a procedure performed in selected obese diabetic patients on the clinical and laboratory parameters. For this purpose, by retrospectively evaluating the clinic files of morbidly obese outpatients who were followed up in Uludag University Medical School, Endocrinology and Metabolism division between 1st January 2011- 1st December 2015, 25 patients who had undergone bariatric surgery and 25 patients who started exenatide treatment were included in the study. The age, gender, antidiabetic medication use, comorbidities, height, weight, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), postprandial glucose (PPG), HbA1c, urea, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), low density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride (TG), total cholesterol (TC), thyroid stimulating hormone (TSH), glucose and protein in spot urine parameters were examined. Although there was a significant reduction in weight and BMIat the 6th month of treatment in the exenatide and LSG groups, the reduction was significantly higher in the LSG group. At the end of the sixmonth follow-up, weight loss was approximately 35.4 kg in the surgery group and 11.5 kg in the exenatide group. Although PPG and HbA1c were significantly decreased in both groups, the decrease was significantly higher in LSG group compared to the exenatide group. Although there was no significant change in FBG in the exenatide group, there was a significant decrease in FBG in LSG group. In both groups there was significant reduction in SBP and DBP at 6 months of treatment, with no significant difference between groups. While there was no significant change in the number and percentage of patients using insulin at 6 months of treatment with exenatide, a significant decrease in total insulin doses used by patients was recorded. In the LSG group there was a significant reduction in the number of patients using insulin but there was no significant change total insulin dose used by patients. At 6th month of treatment with LSG, a significant reduction in TG was seen but there was no significant change in LDL and TC. Besides there was a significant increase in HDL. There was no significant change in the lipid profile in the exenatide group. While a significant reduction was seen in the number of patients who had protein in spot urine compared to baseline at 6 months after bariatric surgery, there was no significant change in the exenatide group. When gender differences were examined, there was no difference between the sexes in terms of percent changes of the parameters, except for a greater reduction in SBP in men using exenatide. There was no significant difference between genders in terms of changesin clinical and laboratory parameters in patients with undergoing LSG. In conclusion, LSG is a method that should be performed upon indication and much more radical compared to exenatide administration but appears to be a more efficient application that corrects diabetes and obesity related metabolic parameters compared to exenatide treatment in diabetic obese patients. However, in the results of our study it was revealed that exenatide hadalso positive effects on obesityrelated diabetic and metabolic parameters.Both treatment options must be evaluated for each patient regarding the advantages and disadvantages and appropriate treatment option for each patient should be decided according to patient's characteristics.
Obesity and diabetes are major causes of morbidity and mortality that are increasing all over the world. As obesity is a major risk factor for type 2 diabetic patients, weight loss has an important place in the treatment of type 2 diabetic patients. There are many studies in the literature comparing the effectiveness of medical and surgical treatmentsin obese type 2 diabetic patients. In our study, we aimed to evaluate and compare the effects of exenatide which is a glucagon-like peptide-1 (GLP1) agonist having an increasing usage in obese diabetic patients and laparoscopic sleeve gastrectomy (LSG) being a procedure performed in selected obese diabetic patients on the clinical and laboratory parameters. For this purpose, by retrospectively evaluating the clinic files of morbidly obese outpatients who were followed up in Uludag University Medical School, Endocrinology and Metabolism division between 1st January 2011- 1st December 2015, 25 patients who had undergone bariatric surgery and 25 patients who started exenatide treatment were included in the study. The age, gender, antidiabetic medication use, comorbidities, height, weight, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), postprandial glucose (PPG), HbA1c, urea, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), low density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride (TG), total cholesterol (TC), thyroid stimulating hormone (TSH), glucose and protein in spot urine parameters were examined. Although there was a significant reduction in weight and BMIat the 6th month of treatment in the exenatide and LSG groups, the reduction was significantly higher in the LSG group. At the end of the sixmonth follow-up, weight loss was approximately 35.4 kg in the surgery group and 11.5 kg in the exenatide group. Although PPG and HbA1c were significantly decreased in both groups, the decrease was significantly higher in LSG group compared to the exenatide group. Although there was no significant change in FBG in the exenatide group, there was a significant decrease in FBG in LSG group. In both groups there was significant reduction in SBP and DBP at 6 months of treatment, with no significant difference between groups. While there was no significant change in the number and percentage of patients using insulin at 6 months of treatment with exenatide, a significant decrease in total insulin doses used by patients was recorded. In the LSG group there was a significant reduction in the number of patients using insulin but there was no significant change total insulin dose used by patients. At 6th month of treatment with LSG, a significant reduction in TG was seen but there was no significant change in LDL and TC. Besides there was a significant increase in HDL. There was no significant change in the lipid profile in the exenatide group. While a significant reduction was seen in the number of patients who had protein in spot urine compared to baseline at 6 months after bariatric surgery, there was no significant change in the exenatide group. When gender differences were examined, there was no difference between the sexes in terms of percent changes of the parameters, except for a greater reduction in SBP in men using exenatide. There was no significant difference between genders in terms of changesin clinical and laboratory parameters in patients with undergoing LSG. In conclusion, LSG is a method that should be performed upon indication and much more radical compared to exenatide administration but appears to be a more efficient application that corrects diabetes and obesity related metabolic parameters compared to exenatide treatment in diabetic obese patients. However, in the results of our study it was revealed that exenatide hadalso positive effects on obesityrelated diabetic and metabolic parameters.Both treatment options must be evaluated for each patient regarding the advantages and disadvantages and appropriate treatment option for each patient should be decided according to patient's characteristics.
Description
Keywords
Obezite, Tip 2 diyabet, Bariyatrik cerrahi, Eksenatid, Obesity, Type 2 diabetes, Bariatric surgery, Exenatide
Citation
Elbasan, O. (2016). Obez tip 2 diyabetik hastalarda bariatrik cerrahi ve eksenatid tedavisinin laboratuar ve klinik parametreler üzerine etkilerinin karşılaştırmalı olarak değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.