Kalyvas Aristotelis V, Vlachos Konstantinos, Abu-Amara Mohammed, Sampalis John S, Glantzounis Georgios
Department of Surgery, School of Medicine, University of Ioannina, 45110, Ioannina, Greece.
Curr Pharm Des. 2014;20(22):3631-46. doi: 10.2174/13816128113196660672.
The recent increase in the prevalence of obesity seems to be responsible for the increase in T2 Diabetes Mellitus (T2DM). At present around 50 % of T2DM patients are obese and this percentage appears set to increase in the near future. Successful management of T2DM in obese patients is a complicated task, as many parameters such as blood pressure, LDL-cholesterol levels have to be adequately controlled along with HbA1c levels. There is a substantial amount of evidence showing that bariatric surgery achieves long term remission of diabetes in the majority of obese patients and improves significantly comorbidities associated with DM such as dyslipidemia, hypertension, and obstructive sleep apnea. It seems that early surgical intervention before irreversible b-cell damage has occurred, increases the chances of long term T2DM resolution. However, at present a very small percentage (< 2%) of obese patients with T2DM is treated surgically. The present review focuses on the efficacy and safety of the main bariatric procedures. It also emphasizes the mechanism with which bariatric surgery exerts its therapeutic effect and on the long term results on T2DM remission.
近期肥胖患病率的上升似乎是2型糖尿病（T2DM）增加的原因。目前，约50%的T2DM患者肥胖，且这一比例在不久的将来似乎还会上升。肥胖患者T2DM的成功管理是一项复杂的任务，因为许多参数，如血压、低密度脂蛋白胆固醇水平以及糖化血红蛋白（HbA1c）水平都必须得到充分控制。大量证据表明，减肥手术能使大多数肥胖患者实现糖尿病的长期缓解，并显著改善与糖尿病相关的合并症，如血脂异常、高血压和阻塞性睡眠呼吸暂停。似乎在不可逆的β细胞损伤发生之前进行早期手术干预，会增加T2DM长期缓解的机会。然而，目前接受手术治疗的肥胖T2DM患者比例非常小（<2%）。本综述重点关注主要减肥手术的疗效和安全性。它还强调了减肥手术发挥治疗作用的机制以及对T2DM缓解的长期效果。
