Marianna Spanou, Konstantinos Tziomalos, First Propedeutic Department of Internal Medicine, Medical School, AHEPA Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
World J Diabetes. 2013 Apr 15;4(2):14-8. doi: 10.4239/wjd.v4.i2.14.
Type 2 diabetes mellitus (T2DM) is a leading cause of blindness, non-traumatic amputation and end-stage renal disease as well as a major cardiovascular risk factor. Tight glycemic control reduces the incidence of microvascular complications of T2DM whereas its effects on macrovascular complication are more controversial. However, glycemic targets are achieved by a minority of diabetic patients despite the availability of several antidiabetic agents. In the present commentary, we discuss the findings of two recent randomized studies that compared bariatric surgery with medical treatment in patients with uncontrolled T2DM. Both studies showed that bariatric surgery results in remission of T2DM in the majority of patients. However, both studies were limited to relatively young patients without comorbidities, had relatively short follow-up and did not assess the effects of surgery on T2DM complications. Moreover, the perioperative complications of bariatric surgery and its limited availability in some areas are additional barriers to the wider implementation of this therapeutic approach. On the other hand, the elucidation of the mechanisms underpinning the resolution of T2DM following bariatric surgery might result in the development of novel, more effective pharmacotherapies for this common disease.
2 型糖尿病（T2DM）是导致失明、非创伤性截肢和终末期肾病的主要原因，也是主要的心血管危险因素。严格的血糖控制可降低 T2DM 微血管并发症的发生率，但其对大血管并发症的影响存在较多争议。然而，尽管有多种抗糖尿病药物可用，但只有少数糖尿病患者能够达到血糖目标。在本评论中，我们讨论了两项最近的随机研究的结果，这些研究比较了肥胖症手术与未经控制的 T2DM 患者的药物治疗。这两项研究均表明，肥胖症手术可使大多数患者的 T2DM 得到缓解。然而，这两项研究都仅限于没有合并症的相对年轻的患者，随访时间相对较短，且未评估手术对 T2DM 并发症的影响。此外，肥胖症手术的围手术期并发症及其在某些地区的有限应用是该治疗方法更广泛应用的额外障碍。另一方面，阐明肥胖症手术后 T2DM 缓解的机制可能会导致为这种常见疾病开发新的、更有效的药物治疗方法。
