Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York, USA.
Annu Rev Med. 2010;61:393-411. doi: 10.1146/annurev.med.051308.105148.
Several gastrointestinal (GI) operations that were designed to promote weight loss can powerfully ameliorate type 2 diabetes mellitus (T2DM). Although T2DM is traditionally viewed as a chronic, relentless disease in which delay of end-organ complications is the major treatment goal, GI surgery offers a novel endpoint: complete disease remission. Ample data confirm the excellent safety and efficacy of conventional bariatric operations-especially Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding-to treat T2DM in severely obese patients. Use of experimental procedures as well as conventional bariatric operations is increasingly being explored in less obese diabetic patients, with generally favorable results, although further assessment of risk:benefit profiles is needed. Mounting evidence indicates that certain operations involving intestinal diversions improve glucose homeostasis through varied mechanisms beyond reduced food intake and body weight, for example by modulating gut hormones. Research to elucidate such mechanisms should facilitate the design of novel pharmacotherapeutics and dedicated antidiabetes GI manipulations. Here we review evidence regarding the use and study of GI surgery to treat T2DM, focusing on available published reports as well as results from the Diabetes Surgery Summit (DSS) in Rome and the World Congress on Interventional Therapies for T2DM in New York City.
几种旨在促进体重减轻的胃肠道（GI）手术可以有力地改善 2 型糖尿病（T2DM）。尽管 T2DM 传统上被视为一种慢性、无情的疾病，其主要治疗目标是延迟终末器官并发症，但 GI 手术提供了一个新的终点：完全疾病缓解。大量数据证实，传统减重手术——特别是 Roux-en-Y 胃旁路术和腹腔镜可调节胃束带术——在严重肥胖患者中治疗 T2DM 的安全性和有效性极佳。越来越多的实验性手术和常规减重手术被用于肥胖程度较轻的糖尿病患者，结果通常是有利的，尽管需要进一步评估风险：获益情况。越来越多的证据表明，某些涉及肠道分流的手术通过除了减少食物摄入和体重之外的不同机制改善葡萄糖稳态，例如通过调节肠道激素。研究这些机制应该有助于设计新的药物治疗和专门的抗糖尿病 GI 操作。在这里，我们回顾了使用 GI 手术治疗 T2DM 的证据，重点介绍了已发表的报告以及在罗马举行的糖尿病手术峰会（DSS）和在纽约市举行的 2 型糖尿病介入治疗世界大会的结果。
