Department of Family Medicine, Ohio University College of Osteopathic Medicine, Athens, OH, USA.
Postgrad Med. 2011 Jan;123(1):24-33. doi: 10.3810/pgm.2011.01.2242.
The prevalence of obesity is increasing and is co-epidemic with type 2 diabetes mellitus (T2DM). Treatment of obesity has been less than adequate, particularly when managing morbidly obese patients. Research on T2DM has shown a number of new pharmacologic therapies along with the rapid employment of bariatric surgery. Improvement of T2DM, including its remission, after bariatric surgery has been recognized for more than a decade. However, not all procedures are the same. Restrictive procedures, malabsorptive procedures, or a combination of both procedures have their own categorical risks and benefits. Which procedure to choose has to do with many patient selection factors, notwithstanding insurance coverage. Based on operative and postoperative mortality data, laparoscopically assisted gastric bypass (LAGB) has been shown to be the safest bariatric surgery procedure. However, the Roux-en-Y gastric bypass procedure is one of the most widely used for obese patients with T2DM. The mechanisms involved in weight loss and improved blood glucose control appear to involve increased insulin sensitivity, decreased lipotoxicity/inflammation, and changes in gut hormones/incretins. The safety of bariatric procedures has improved; complication rates are low and mortality is < 1% for all procedures. As a result of the dramatic, positive impact of bariatric procedures on T2DM in obese patients, physicians should be cautious during patient selection to avoid performing the procedure on patients who are overzealous about reported outcomes, but who are not candidates for the procedure. Other data gaps still exist regarding diabetes surgery, which must be filled using data from well-designed, well-implemented randomized controlled clinical trials. In the future, it will be prudent to compare surgical interventions with other rigorous medical interventions in more robust studies. A combination of surgical, medical, and behavioral interventions should be considered for treating obese patients with T2DM.
肥胖的患病率正在上升，并与 2 型糖尿病（T2DM）同时流行。肥胖的治疗一直不够充分，尤其是在管理病态肥胖患者时。T2DM 的研究已经显示了许多新的药物治疗方法，以及快速采用减重手术。减重手术后 T2DM 的改善，包括其缓解，已经得到了十多年的认可。然而，并非所有的手术都是一样的。限制程序、吸收不良程序或两者的组合都有其自身的分类风险和益处。选择哪种手术程序与许多患者选择因素有关，而与保险覆盖范围无关。根据手术和术后死亡率数据，腹腔镜辅助胃旁路术（LAGB）已被证明是最安全的减肥手术。然而，Roux-en-Y 胃旁路术是治疗肥胖 T2DM 患者最广泛使用的手术之一。体重减轻和改善血糖控制的机制似乎涉及增加胰岛素敏感性、降低脂肪毒性/炎症和改变肠道激素/肠促胰岛素。减肥手术的安全性已经提高；所有手术的并发症发生率低，死亡率<1%。由于减肥手术对肥胖患者 T2DM 的显著积极影响，医生在选择患者时应谨慎，避免对报告结果过于热衷但不适合手术的患者进行手术。关于糖尿病手术，仍存在其他数据空白，必须使用精心设计和实施的随机对照临床试验的数据来填补。在未来，将明智的是在更有力的研究中比较手术干预与其他严格的医疗干预。应考虑将手术、医疗和行为干预相结合，以治疗肥胖的 T2DM 患者。
