Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Sart Tilman, University of Liège, Liège, Belgium.
Diabetes Metab. 2009 Dec;35(6 Pt 2):537-43. doi: 10.1016/S1262-3636(09)73463-9.
Obesity plays a key role in the pathophysiology of type 2 diabetes (T2DM), and weight loss is a major objective, although difficult to achieve with medical treatments. Bariatric surgery has proven its efficacy in obtaining marked and sustained weight loss, and is also associated with a significant improvement in glucose control and even diabetes remission. Roux-en-Y gastric bypass appears to be more effective in diabetic patients than the restrictive gastroplasty procedure. This may be explained not only by greater weight reduction, but also by specific hormonal changes. Indeed, increased levels of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) may lead to improved beta-cell function and insulin secretion as well as reduced insulin resistance associated with weight loss. The presence of T2DM in obese individuals is a further argument to propose bariatric surgery, and even more so when diabetes is difficult to manage by medical means and other weight-related complications may occur. Bariatric surgery is associated with a better cardiovascular prognosis and reduced mortality, even though acute and long-term complications are present. The observation that surgical rerouting of nutrients triggers changes in the release of incretin hormones that, in turn, ameliorate the diabetic state in the absence of weight loss has led to the recent development of innovative surgical procedures. Thus, bariatric surgery may be said to be progressing towards so-called 'metabolic surgery', which merits further evaluation in patients with T2DM within a multidisciplinary approach that involves both surgeons and endocrinologists.
肥胖在 2 型糖尿病（T2DM）的病理生理学中起着关键作用，减轻体重是主要目标，但用医学治疗很难实现。减重手术已被证明在获得显著和持续的体重减轻方面是有效的，并且还与葡萄糖控制的显著改善甚至糖尿病缓解相关。与限制型胃成形术相比，Roux-en-Y 胃旁路术似乎对糖尿病患者更有效。这可能不仅归因于更大程度的体重减轻，还归因于特定的激素变化。实际上，胰高血糖素样肽-1（GLP-1）和葡萄糖依赖性胰岛素释放肽（GIP）水平的增加可能导致改善的β细胞功能和胰岛素分泌，以及与体重减轻相关的胰岛素抵抗降低。肥胖个体中存在 T2DM 是建议进行减重手术的另一个理由，而当糖尿病难以通过医学手段控制且可能发生其他与体重相关的并发症时，这一点更为重要。减重手术与更好的心血管预后和降低的死亡率相关，尽管存在急性和长期并发症。观察到营养物质的手术改道会引发肠促胰岛素激素释放的变化，这反过来又在没有体重减轻的情况下改善了糖尿病状态，这导致了创新性手术程序的最近发展。因此，可以说减重手术正在朝着所谓的“代谢手术”发展，这在涉及外科医生和内分泌学家的多学科方法中，值得在 T2DM 患者中进一步评估。
