Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.
Curr Opin Endocrinol Diabetes Obes. 2012 Oct;19(5):352-8. doi: 10.1097/MED.0b013e328357f0e0.
To critically discuss the strengths and shortcomings of recent progress achieved with bariatric surgery in patients with type 2 diabetes mellitus (T2DM), focussing on efficacy aspects (remission of diabetes and cardiovascular comorbidities). Despite an increasing armamentarium of pharmacotherapeutics to overcome several challenges, only 10% of T2DM patients achieve a composite goal of HbA1c, blood pressure and lipids. Bariatric surgery has emerged as a solution to these challenges in morbid obesity. Whether the same advantages can be translated into T2DM remains a matter of debate, certainly regarding safety, durability of diabetes recovery and long-term outcome.
Bariatric surgery in T2DM patients with a BMI of at least 35 kg/m(2) has been shown to result in a 56% excess body weight loss, resolution of hypertension in 62%, amelioration of dyslipidaemia in greater than 70% and diabetes remission in 57-95%, depending on the type of surgery and the definition of diabetes resolution. These impressive results, and the fact that diabetes recovery often occurs before prominent weight loss is evident, have urged bariatric surgeons to consider surgical procedures as a valuable approach for diabetes control and diabetes remission in patients with a BMI ranging between 30 and 35 kg/m(2).
Bariatric surgery is emerging as a valid option to treat T2DM, improving glycaemia and cardiovascular risk factors. However, there needs to be an agreed definition of resolution of diabetes in future studies and long-term efficacy is to be proven. For now, the challenge is to determine how to offer bariatric surgery in a responsible fashion.
批判性地讨论肥胖症手术治疗 2 型糖尿病（T2DM）的近期进展，重点讨论疗效方面（糖尿病缓解和心血管合并症）。尽管有越来越多的药物治疗方法来克服多种挑战，但只有 10%的 T2DM 患者达到了糖化血红蛋白、血压和血脂的综合目标。肥胖症手术已成为治疗病态肥胖的一种方法。同样的优势是否可以转化为 T2DM 仍然存在争议，尤其是在安全性、糖尿病恢复的持久性和长期结果方面。
对于 BMI 至少为 35kg/m²的 T2DM 患者，肥胖症手术已被证明可导致 56%的超重体重减轻，62%的高血压缓解，70%以上的血脂异常改善，57-95%的糖尿病缓解，具体取决于手术类型和糖尿病缓解的定义。这些令人印象深刻的结果，以及糖尿病恢复往往在明显体重减轻之前发生的事实，促使肥胖症外科医生考虑将手术作为控制糖尿病和 BMI 在 30 至 35kg/m²之间的患者的糖尿病缓解的一种有价值的方法。
肥胖症手术正在成为治疗 T2DM 的有效选择，可改善血糖和心血管危险因素。然而，未来的研究需要有一个关于糖尿病缓解的明确定义，长期疗效仍有待证明。目前的挑战是确定如何以负责任的方式提供肥胖症手术。
