| Part1 Evaluation of metabolic surgery effectiveness and the impact of metabolic surgery on food addiction after operation in obese type 2 diabetes mellitus patientsObjective To observe the effect of metabolic surgery and the changes of food addiction after operation on obese type 2 diabetes mellitus(T2DM)PatientsMethods A retrospective study was performed to review the clinical data of 76 patients with obese type 2 diabetes mellitus in the obesity clinic of Changhai Hospital,The Second Military Medical University,from January 2010 to November 2015.Patients who had undergone metabolic Surgery(operation group,38 cases)or traditional medical treatment(non-operation group/control group,38 cases)was evaluated by Yale Food Addiction Scale(YFAS)before and after therapy.We conducted a case—control study to analyze the targets of blood glucose/ obesity and the food addiction status of the two groups before and after therapy.The data were compared between the operation group and the non-operation group using rank sum test and T test.The data of YFAS were analyzed by Mc Nemar test within groups while inter-group comparisons by rank sum test.Results 1.Significant differences between the operation and control groups were observed in patient’s fasting blood glucose(FBG),hemoglobin A1c(Hb A1c),fasting C-Peptide(FCP),body weight,waistline and Body Mass Index(BMI)value differences before and after treatment(Z=2.38~6.7,P<0.05),Compared with control group,fasting blood glucose(2.71±2.35)vs(1.07±1.71)mmol/L、Hb A1c(1.81±1.52)vs(0.87±0.97)%、FC-Peptide(2.60±3.49)vs(1.42±1.90)ug/L、body weight(28.46±15.57)vs(7.42±6.40)kg、waistline(31.38±15.74)vs(5.89±6.44)cm、and Body Mass Index(10.03±5.79)vs(2.67±2.29)kg/m2,were significantly improved in operation group.2.Among the five investigation questions of food addiction[Q1: I find that when I start eating certain foods,I end up eating much more than I had planned.Q2:There have been times when I consumed certain foods so often or in such large quantities that I spent time dealing with negative feelings from overeating instead of working,spending time with my family or friends,or engaging in other important activities or recreational activities I enjoy.Q3: I kept consuming the same types of food or the same amount of food even though I was having emotional and/or physical problems.Q4: I have had withdrawal symptoms when I cut down or stopped eating certain foods.(Please do NOT include withdrawal symptoms caused by cutting down on caffeinated beverages such as soda pop,coffee,tea,energy drinks,etc.)For example: Developing physical symptoms,feeling agitated,or feeling anxious.Q5: My behavior with respect to food and eating causes significant distress],the operation group demonstrated significant statistical difference for all questions(Q1、Q2、Q3、Q4、Q5)after operation(c2=13~28,P<0.05),while control group showed statistical difference for four questions(Q1、Q2、Q3、Q4)after traditional medical treatment(c2=5.4444~11.2667,P<0.05);Significant differences were observed in inter-group comparison for three questions(Q1、Q2、Q3)(Z=2.85~3.29,P<0.05),with the operation group improved significantly,The average difference(operation group /control group)is(0.71 vs 0.34、0.73 vs 0.32、0.65 vs 0.29).Conclusion compared with traditional medical treatment,obese type 2 diabetes mellitus patients undergone metabolic surgery can improve targets of blood glucose/ obesity.The food addiction status of obese T2 DM Patients after metabolic surgery and traditional medical treatment was improved,with the extent of improvement in the operation group being greater.Part2 Study of low-carbohydrate diet intervention in obese type 2 diabetes mellitus patients after metabolic surgeryObjective To observe the improvement of weight rebound in obese type 2 diabetes mellitus patients who had undergone metabolic Surgery after low-carbohydrate diet intervention.Methods To observe the clinical data of 38 patients with obese type 2 diabetes mellitus who had undergone metabolic surgery in the obesity clinic of Changhai Hospital,The Second Military Medical University,from January 2010 to November 2015.The patients were randomly divided into two groups and intervened by low carbohydrate(LC)diet or diabetes mellitus(DM)diet for six months.The blood glucose and body weight of the two groups were observed.Comparisons of post-operation different diet intervention continuous data were performed by rank sum test and T test.Inter-group comparisons for weight rebound rates were analyzed using Fisher exact test.Results fasting blood glucose,hemoglobinA1 c,fasting C-Peptide,body weight,waistline and Body Mass Index value in patients who accepted metabolic surgery with diabetes mellitus diet intervention have no statistical difference(t=0.34,S=1.00~32.5,P>0.05)before and after intervention;while the indexes(fasting blood glucose、body weight、waistline and Body Mass Index)in patients who accepted metabolic surgery with low-carbohydrate diet intervention have significant statistical difference(t=2.38,S=17~24.5,P<0.05)before and after intervention.There were significant differences in body weight difference(Z=2.31,P<0.05),Body Mass Index difference(Z=2.36,P<0.05),weight rebound rate(P<0.05)in inter-group comparison,with the low carbohydrate diet intervention group displaying advantaged.Conclusion low carbohydrate diet intervention can improve fasting blood glucose,obesity indexes in obese type 2 diabetes mellitus Patients after metabolic surgery.Compared with diabetes mellitus diet intervention,low carbohydrate diet intervention after metabolic surgery can more greatly improve weight,weight rebound rate and rebound scale in obese type 2 diabetes mellitus Patients and have more advantages for maintaining the operation effects. |
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