위절제술 후 발생하는 당뇨병의 원인과 병태생리에 관한 연구 (A Study on the Change of Glucose Metabolism after Gastrectomy)

서지정보

· 발행기관 : 고신대학교(의대) 고신대학교 의과대학 학술지
· 수록지 정보 : 고신대학교 의과대학 학술지 / 11권 / 1호 / 75 ~ 84페이지
· 저자명 : 최영식, 고용호, 박요한

초록

-Abstract- Recently several cases of diabetes were found after undergoing gastrectomy. The loss of stomach profoundly affects glucose metabolism which may lead to the development of diabetes in a certain group of patients, particularly those with diabetic risk factors such as family history, obesity and other insulin resistance states. The purpose of this study is to investigate the changes in the plasma lipids and glucose metabolism and the risk factors of diabetes in patients who are planned to undergo gastrectomy so that it may help for the treatment and prevention of gastrectomy-related diabetes.
The non-diabetic patients who admitted to Kosin Medical Center for gastrectomy were prospectively studied since March 1, 1995. They were divided into 2 groups; those with family history of diabetes, overweight, obesity or impaired glucose tolerance on oral glucose tolerance test (OGTT) (group Ⅰ, n=5) and those without (group Ⅱ, n=5). The ability to control blood glucose was evaluated by measuring blood glucose, insulin, C-peptide and glucagon during OGTT which was performed before and 1 month after gastrectomy.
Ten out of 34 patients who entered the study were followed at 1 month after gastrectomy. Body weight decreased from 58.1±9.7kg to 54.9±7.3kg and values of other parameters of nutritional status also decreased. The levels of blood glucose, insulin, C-peptide, and glucagon generally increased at 0, 60 and 120 minutes during postoperative OGTT as compared to those levels during preoperative OGTT. The blood glucose level increased from 147.6±31.5 to 178.2±45.7 mg/dl at 60 min (p=0.07) and the insulin level increased from 38.1±27.0 uU/ml to 113.6±96.1 uU/ml at 60 min (p=0.05). In preoperative OGTT the insulin level was higher at 60 min and at 120 min in group Ⅰ than group Ⅱ (56.7±23.9 uU/ml vs 19.4±11.6 uU/ml, p=0.03, 36.1±21.4 uU/ml vs 8.5±6.9 uU/ml, p=0.03, respectively). Most patient took three meals a day and highly concentrated carbohydrate such as honey between meals. Impaired glucose tolerance developed postoperatively in one woman of overweight group but none of normal weight group.
The development of impaired glucose tolerance in one of 3 overweighted women and abnormal glucose metabolism in general after gastrectomy suggests that postoperative risk of development of impaired glucose tolerance be substantial, particularly in patients with diabetic risk factors such as obesity. To prevent the development of postoperative abnormal glucose metabolism adequate weight control before operation, preferably from young age, and postoperative measures to decrease excessive insulin secretion and hence insulin resistance, such as frequent small meals which consist of low carbohydrate and increased mono- and polyunsaturated fatty acid are suggested.

영어초록

-Abstract- Recently several cases of diabetes were found after undergoing gastrectomy. The loss of stomach profoundly affects glucose metabolism which may lead to the development of diabetes in a certain group of patients, particularly those with diabetic risk factors such as family history, obesity and other insulin resistance states. The purpose of this study is to investigate the changes in the plasma lipids and glucose metabolism and the risk factors of diabetes in patients who are planned to undergo gastrectomy so that it may help for the treatment and prevention of gastrectomy-related diabetes.
The non-diabetic patients who admitted to Kosin Medical Center for gastrectomy were prospectively studied since March 1, 1995. They were divided into 2 groups; those with family history of diabetes, overweight, obesity or impaired glucose tolerance on oral glucose tolerance test (OGTT) (group Ⅰ, n=5) and those without (group Ⅱ, n=5). The ability to control blood glucose was evaluated by measuring blood glucose, insulin, C-peptide and glucagon during OGTT which was performed before and 1 month after gastrectomy.
Ten out of 34 patients who entered the study were followed at 1 month after gastrectomy. Body weight decreased from 58.1±9.7kg to 54.9±7.3kg and values of other parameters of nutritional status also decreased. The levels of blood glucose, insulin, C-peptide, and glucagon generally increased at 0, 60 and 120 minutes during postoperative OGTT as compared to those levels during preoperative OGTT. The blood glucose level increased from 147.6±31.5 to 178.2±45.7 mg/dl at 60 min (p=0.07) and the insulin level increased from 38.1±27.0 uU/ml to 113.6±96.1 uU/ml at 60 min (p=0.05). In preoperative OGTT the insulin level was higher at 60 min and at 120 min in group Ⅰ than group Ⅱ (56.7±23.9 uU/ml vs 19.4±11.6 uU/ml, p=0.03, 36.1±21.4 uU/ml vs 8.5±6.9 uU/ml, p=0.03, respectively). Most patient took three meals a day and highly concentrated carbohydrate such as honey between meals. Impaired glucose tolerance developed postoperatively in one woman of overweight group but none of normal weight group.
The development of impaired glucose tolerance in one of 3 overweighted women and abnormal glucose metabolism in general after gastrectomy suggests that postoperative risk of development of impaired glucose tolerance be substantial, particularly in patients with diabetic risk factors such as obesity. To prevent the development of postoperative abnormal glucose metabolism adequate weight control before operation, preferably from young age, and postoperative measures to decrease excessive insulin secretion and hence insulin resistance, such as frequent small meals which consist of low carbohydrate and increased mono- and polyunsaturated fatty acid are suggested.

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