Benedix F, Meyer F, Klose S, Stroh C, Lippert H
Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg.
Universitätsklinik für Nieren- und Hochdruckkrankheiten, Diabetologie und Endokrinologie, Universitätsklinikums Magdeburg.
Dtsch Med Wochenschr. 2014 Jan;139(5):207-12. doi: 10.1055/s-0033-1359931. Epub 2014 Jan 21.
Typ 2 diabetes mellitus (T2DM) can be regarded as a chronic and progressive disease which is rapidly increasing worldwide. There is a significant coincidence of T2DM and obesity, the latter playing a major role in the development of insulin resistance. Medical treatment comprises lifestyle counseling, weight management and an increased physical activity, frequently in combination with pharmacotherapy. However, especially in obese patients, metabolic aims are frequently not achieved which can be attributed to the lack of significant weight reduction. Currently, pancreas transplantation plays only a minor role in the treatment of patients with T2DM. Bariatric surgery has been proven to be a safe and effective therapeutic option in obese patients that leads to a significant weight loss. Moreover, in the majority of obese diabetics, a complete or partial remission of T2DM is observed. The significant weight loss is associated with improved insulin sensitivity. There is some evidence that alterations of gut hormones play an additional role in the amelioration of T2DM. However, little is known about the long-term effect of bariatric surgery on diabetes remission. Bariatric procedures should be considered in obese patients with T2DM (BMI > 35 kg/m²) and poorly controlled metabolic status. Despite the encouraging results in normal weight or overweight patients with T2DM, surgery can not yet be recommended in these patients. Intensive research about the impact of bariatric surgery on diabetes remission offers a unique opportunity to understand pathophysiology of T2DM. Furthermore, it may help to develop less invasive interventions and to identify new therapeutic targets for the treatment of T2DM.
2型糖尿病（T2DM）可被视为一种慢性进行性疾病，在全球范围内正迅速增加。T2DM与肥胖症有显著的相关性，后者在胰岛素抵抗的发展中起主要作用。医学治疗包括生活方式咨询、体重管理和增加体育活动，通常与药物治疗相结合。然而，尤其是在肥胖患者中，代谢目标常常无法实现，这可能归因于体重没有显著减轻。目前，胰腺移植在T2DM患者的治疗中仅起次要作用。减肥手术已被证明是肥胖患者一种安全有效的治疗选择，可导致显著的体重减轻。此外，在大多数肥胖糖尿病患者中，可观察到T2DM完全或部分缓解。显著的体重减轻与胰岛素敏感性改善相关。有一些证据表明，肠道激素的改变在T2DM的改善中起额外作用。然而，关于减肥手术对糖尿病缓解的长期影响知之甚少。对于T2DM（BMI>35kg/m²）且代谢状态控制不佳的肥胖患者，应考虑进行减肥手术。尽管在体重正常或超重的T2DM患者中取得了令人鼓舞的结果，但目前仍不建议对这些患者进行手术。对减肥手术对糖尿病缓解影响的深入研究为了解T2DM的病理生理学提供了一个独特的机会。此外，这可能有助于开发侵入性较小的干预措施，并确定T2DM治疗的新靶点。
