Shimizu Hideharu, Timratana Poochong, Schauer Philip R, Rogula Tomasz
M61 Cleveland Clinic, Bariatric and Metabolic Institute, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
J Obes. 2012;2012:147256. doi: 10.1155/2012/147256. Epub 2012 Jun 5.
Bariatric/metabolic surgery is considered an accepted treatment option for type 2 diabetes mellitus (T2DM) with body mass index (BMI) ≧ 35 kg/m(2). Mounting evidence also shows that metabolic surgery is effective for T2DM with BMI < 35 kg/m(2). To evaluate current status of metabolic surgery, we reviewed the available clinical studies which described surgical treatment for T2DM with mean BMI < 35 kg/m(2). 18 studies with 477 patients were identified. 30% of the patients was insulin users. The follow-up period ranged from 6 to 216 months. The weight loss effect was reasonable, not excessive. Mean BMI decreased from 30.4 to 24.8 kg/m(2). Remission of T2DM was achieved in 64.7% of the patients with fasting plasma glucose and glycated hemoglobin approaching slightly above normal range. Clinical T2DM status was an important factor when selecting the eligible candidates for metabolic surgery. Postoperative complication rate of 10.3% with mortality of 0% in the studies has been acceptable. Even though it would be premature at this point to state that metabolic surgery is an accepted treatment option for T2DM with BMI < 35 kg/m(2), it is clear that a high proportion of T2DM patients will derive substantial benefit from metabolic surgery.
对于体重指数（BMI）≧35kg/m²的2型糖尿病（T2DM）患者，减重/代谢手术被视为一种公认的治疗选择。越来越多的证据还表明，代谢手术对BMI<35kg/m²的T2DM患者也有效。为评估代谢手术的现状，我们回顾了现有描述BMI<35kg/m²的T2DM患者手术治疗的临床研究。共纳入18项研究，涉及477例患者。30%的患者使用胰岛素。随访时间为6至216个月。体重减轻效果合理，不过度。平均BMI从30.4降至24.8kg/m²。64.7%的患者实现了T2DM缓解，空腹血糖和糖化血红蛋白略高于正常范围。临床T2DM状态是选择代谢手术合适候选人时的一个重要因素。这些研究中术后并发症发生率为10.3%，死亡率为0%，这是可以接受的。尽管目前称代谢手术是BMI<35kg/m²的T2DM患者的一种公认治疗选择还为时过早，但显然很大一部分T2DM患者将从代谢手术中获得显著益处。
