Levy Pierre, Fried Martin, Santini Ferruccio, Finer Nick
LEGOS, University of Paris Dauphine, Paris, France.
Obes Surg. 2007 Sep;17(9):1248-56. doi: 10.1007/s11695-007-9214-z.
Epidemiological evidence confirms that risk of developing type 2 diabetes is related to weight gain. Weight reduction is beneficial as relative risk is reduced to 0.13 for weight loss >20 kg. This raises the question of effectiveness of bariatric surgery on 1) weight loss and 2) diabetes-related outcomes in morbidly obese patients.
We reviewed the literature using Medline. Only 2 meta-analyses reporting on both outcomes were included, as well as 50 systematic reviews or primary studies.
Meta-analyses mainly based on case series data as well as controlled studies confirm that bariatric surgery is highly effective in obtaining weight reduction in morbidly obese patients up to 60% of the excess weight, along with resolution of preoperative diabetes in more than 75% of cases. Among bariatric surgery techniques, malabsorptive procedures (biliopancreatic diversion and gastric bypass) appear to be more effective on both outcomes than restrictive procedures (gastroplasty and gastric banding).
Even if more studies are needed to confirm current evidence, bariatric surgery is effective for controlling diabetes. It appears as an efficient strategy from economic modeling due to savings from reduction in diabetes-related costs.
流行病学证据证实，患2型糖尿病的风险与体重增加有关。体重减轻是有益的，因为体重减轻超过20千克时相对风险可降至0.13。这就提出了一个问题，即减肥手术对病态肥胖患者的1）体重减轻和2）糖尿病相关结局的有效性。
我们使用Medline检索了文献。仅纳入了2项报告这两种结局的荟萃分析，以及50项系统评价或原始研究。
主要基于病例系列数据以及对照研究的荟萃分析证实，减肥手术在使病态肥胖患者减轻体重方面非常有效，减轻幅度可达超重部分的60%，同时超过75%的病例术前糖尿病得到缓解。在减肥手术技术中，吸收不良手术（胆胰分流术和胃旁路术）在这两种结局方面似乎比限制性手术（胃成形术和胃束带术）更有效。
即使需要更多研究来证实现有证据，但减肥手术对控制糖尿病是有效的。从经济模型来看，由于糖尿病相关费用的降低带来了节省，它似乎是一种有效的策略。
