Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, OH 44195, USA.
Diabetes Obes Metab. 2012 Sep;14(9):773-79. doi: 10.1111/j.1463-1326.2012.01577.x. Epub 2012 Feb 21.
Residual diabetes following bariatric surgery is increasingly recognized despite initial weight loss. It occurs more commonly following banding and sleeve gastrectomy procedures than with gastric bypass, is associated with long duration and advanced stages of diabetes and is exacerbated by weight regain. Long-term diabetes management following various gastric restrictive surgery (i.e. lap banding) requires targeting weight loss, insulin resistance and insulin secretion defects with antidiabetic agents that have weight negative or neutral effects. In contrast, re-emergence of hyperglycaemia following gastric bypass may require targeting β-cell failure with insulin analogues. Revisional bariatric surgery is also a consideration. On the basis of our experience, we propose a clinical approach for long-term management of diabetes following various bariatric procedures in the presence and absence of weight regain that is based on recognized pathophysiological effects of these procedures on diabetes remission.
尽管最初体重减轻，减重手术后仍会出现残余糖尿病，这一现象越来越被人们所认识。与胃旁路术相比，这种情况在胃带和胃袖状切除术之后更为常见，与糖尿病的长期和晚期有关，并且体重反弹会加重这种情况。各种胃限制手术（即胃带）后的长期糖尿病管理需要用具有体重负或中性作用的抗糖尿病药物来针对减肥、胰岛素抵抗和胰岛素分泌缺陷进行治疗。相比之下，胃旁路术后血糖再次升高可能需要用胰岛素类似物针对β细胞衰竭进行治疗。再次进行减肥手术也是一种考虑。根据我们的经验，我们提出了一种针对各种减肥手术后（无论是否出现体重反弹）长期管理糖尿病的临床方法，该方法基于这些手术对糖尿病缓解的病理生理学影响。
