Abstract：
OBJECTIVE: Postprandial glycemic fluctuations after gastrectomy are seen in patients with gastric cancer but, no studies have investigated the association between gastrectomy and type 2 diabetes mellitus (T2DM) in gastric cancer survivors. This study aimed to elucidate the relationship between gastrectomy (total or subtotal) and incident T2DM. In addition, we explored whether vitamin B12 supplementation modulates this risk among patients who have undergone total gastrectomy.
METHODS: In this large nationwide population-based retrospective cohort study using the National Health Insurance Service database of South Korea, we identified patients aged >20 years who underwent gastrectomy from 2008 to 2015 (n = 150,074) and age- and sex-matched controls without gastrectomy (n = 301,508). A Cox proportional hazards model was used.
RESULTS: During the median follow-up duration of 4.4 years after the 2-year time lag after gastrectomy, of the 78,006 subjects, 4,597 (5.9 %) developed T2DM. Compared with matched controls, the adjusted hazard ratio (AHR[95 % confidence interval]) for T2DM of patients with total gastrectomy was 1.34[1.23;1.47]. The corresponding AHR after subtotal gastrectomy was 0.81[0.76;0.86]. Among the patients with total gastrectomy, the risk of T2DM was significantly increased in those who did not receive any vitamin B12 supplementation (AHR=1.60[1.33;1.92]), whereas the risk of T2DM was lower (close to being statistically significant) in those who received continuous vitamin B12 supplementation after gastrectomy (AHR=0.70[0.49;1.01]).
CONCLUSIONS: These results show a significantly reduced risk of T2DM in gastric cancer patients undergoing subtotal gastrectomy and a significantly increased risk of T2DM in gastric cancer patients undergoing total gastrectomy, which is mitigated by continuous vitamin B12 supplementation.
METHODS: In this large nationwide population-based retrospective cohort study using the National Health Insurance Service database of South Korea, we identified patients aged >20 years who underwent gastrectomy from 2008 to 2015 (n = 150,074) and age- and sex-matched controls without gastrectomy (n = 301,508). A Cox proportional hazards model was used.
RESULTS: During the median follow-up duration of 4.4 years after the 2-year time lag after gastrectomy, of the 78,006 subjects, 4,597 (5.9 %) developed T2DM. Compared with matched controls, the adjusted hazard ratio (AHR[95 % confidence interval]) for T2DM of patients with total gastrectomy was 1.34[1.23;1.47]. The corresponding AHR after subtotal gastrectomy was 0.81[0.76;0.86]. Among the patients with total gastrectomy, the risk of T2DM was significantly increased in those who did not receive any vitamin B12 supplementation (AHR=1.60[1.33;1.92]), whereas the risk of T2DM was lower (close to being statistically significant) in those who received continuous vitamin B12 supplementation after gastrectomy (AHR=0.70[0.49;1.01]).
CONCLUSIONS: These results show a significantly reduced risk of T2DM in gastric cancer patients undergoing subtotal gastrectomy and a significantly increased risk of T2DM in gastric cancer patients undergoing total gastrectomy, which is mitigated by continuous vitamin B12 supplementation.
摘要：
目的：胃癌患者在胃切除术后出现餐后血糖波动，尚无研究调查胃癌患者胃切除术与2型糖尿病(T2DM)之间的关系.本研究旨在阐明胃切除术（全切术或次全切术）与T2DM发病之间的关系。此外,我们探讨了补充维生素B12是否能调节全胃切除术患者的这种风险.
方法：在这项使用韩国国民健康保险服务数据库的大规模全国人群回顾性队列研究中，我们确定了在2008年至2015年期间接受胃切除术的年龄>20岁的患者(n=150,074),以及年龄和性别相匹配的未接受胃切除术的对照(n=301,508).使用Cox比例风险模型。
结果：在胃切除术后2年的滞后时间后，中位随访时间为4.4年，在78,006个科目中，4597（5.9%）发展为T2DM。与匹配的对照相比，全胃切除术后T2DM患者的校正风险比(AHR[95%置信区间])为1.34[1.23;1.47].胃大部切除术后相应的AHR为0.81[0.76;0.86]。在全胃切除术的患者中，未补充任何维生素B12的患者患T2DM的风险显著增加(AHR=1.60[1.33;1.92]),而在胃切除术后接受持续补充维生素B12的患者中,T2DM的风险较低(接近统计学意义)(AHR=0.70[0.49;1.01]).
结论：这些结果表明，在接受胃大部切除术的胃癌患者中，T2DM的风险显著降低，而在接受全胃切除术的胃癌患者中，T2DM的风险显著增加。通过持续补充维生素B12来缓解。
方法：在这项使用韩国国民健康保险服务数据库的大规模全国人群回顾性队列研究中，我们确定了在2008年至2015年期间接受胃切除术的年龄>20岁的患者(n=150,074),以及年龄和性别相匹配的未接受胃切除术的对照(n=301,508).使用Cox比例风险模型。
结果：在胃切除术后2年的滞后时间后，中位随访时间为4.4年，在78,006个科目中，4597（5.9%）发展为T2DM。与匹配的对照相比，全胃切除术后T2DM患者的校正风险比(AHR[95%置信区间])为1.34[1.23;1.47].胃大部切除术后相应的AHR为0.81[0.76;0.86]。在全胃切除术的患者中，未补充任何维生素B12的患者患T2DM的风险显著增加(AHR=1.60[1.33;1.92]),而在胃切除术后接受持续补充维生素B12的患者中,T2DM的风险较低(接近统计学意义)(AHR=0.70[0.49;1.01]).
结论：这些结果表明，在接受胃大部切除术的胃癌患者中，T2DM的风险显著降低，而在接受全胃切除术的胃癌患者中，T2DM的风险显著增加。通过持续补充维生素B12来缓解。
