State University of New York Health Science Center at Brooklyn, Brooklyn, New York 11203, USA.
Curr Opin Endocrinol Diabetes Obes. 2012 Oct;19(5):359-66. doi: 10.1097/MED.0b013e328358301f.
Bariatric surgery is an important option for the treatment of severe (type III) obesity. Its role in the management of type 2 diabetes in overweight and obese patients needs to be defined.
Intensified medical therapy can achieve target metabolic goals in many but not all patients with type 2 diabetes. Bariatric surgery can normalize or improve glycemia in severely obese patients with type 2 diabetes. The complications of bariatric surgery are significant and include operative mortality, early and late surgical complications and late nutritional deficiencies. Comparative studies of bariatric surgery versus intensive medical therapy in the management and clinical outcomes of patients with type 2 diabetes are needed to evaluate relative risk/benefit of each. Bariatric surgery studies in type 2 diabetes are lacking long-term follow-up metabolic and clinical outcomes data.
Current data are insufficient to recommend bariatric surgery as a primary treatment for type 2 diabetes. However, it can be recommended for patients whose target metabolic control cannot be achieved by intensive glycemic control because of intolerance or inadequate responses to nutritional and pharmacologic treatments.
减重手术是治疗严重（III 型）肥胖的重要手段。但需要明确其在超重和肥胖的 2 型糖尿病患者治疗中的作用。
强化药物治疗可以使大多数但并非所有 2 型糖尿病患者达到代谢目标。减重手术可以使 2 型糖尿病的严重肥胖患者血糖正常化或改善。减重手术的并发症显著，包括手术死亡率、早期和晚期手术并发症以及晚期营养缺乏。需要进行减重手术与强化药物治疗对比研究，以评估每种治疗方法的相对风险/获益。2 型糖尿病减重手术研究缺乏长期随访的代谢和临床结局数据。
目前的数据不足以推荐减重手术作为 2 型糖尿病的主要治疗手段。然而，对于因不耐受或对营养和药物治疗反应不足而无法通过强化血糖控制达到目标代谢控制的患者，可以推荐其进行减重手术。
