Blüher M
Department für Innere Medizin, Universität Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland,
Chirurg. 2014 Nov;85(11):957-62. doi: 10.1007/s00104-014-2795-x.
Obesity significantly increases the risk of developing type 2 diabetes by a factor of up to 9. Medical treatment of type 2 diabetes with lifestyle and pharmacological interventions frequently fails to prevent the progress of the disease and the manifestation of diabetes complications. In recent years bariatric metabolic surgery has emerged as an effective treatment for patients with obesity and type 2 diabetes. Compared to medical treatment alone, metabolic surgery has been shown to be more effective in reducing mortality, improving hyperglycemia, hypertension and dyslipidemia in randomized clinical trials among patients with obesity and type 2 diabetes. However, surgery also has the risk for acute perioperative complications, long-term micronutrient deficiencies and psychological problems. Weighing these risks against the benefits of significant weight loss and improved glycemic control, metabolic surgery seems to be a promising treatment option for obesity-associated type 2 diabetes. However, current guidelines and treatment algorithms for the treatment of type 2 diabetes either ignore or underestimate the potential of metabolic surgery. In my opinion, metabolic surgery should be considered earlier in the treatment of type 2 diabetes and obesity and no longer be considered as the last therapeutic option for patients with obesity-associated type 2 diabetes.
肥胖会使患2型糖尿病的风险显著增加，最高可达9倍。通过生活方式和药物干预对2型糖尿病进行医学治疗往往无法阻止疾病进展和糖尿病并发症的出现。近年来，减重代谢手术已成为肥胖和2型糖尿病患者的有效治疗方法。在肥胖和2型糖尿病患者的随机临床试验中，与单纯药物治疗相比，代谢手术在降低死亡率、改善高血糖、高血压和血脂异常方面更有效。然而，手术也有围手术期急性并发症、长期微量营养素缺乏和心理问题的风险。权衡这些风险与显著减重和改善血糖控制的益处，代谢手术似乎是肥胖相关2型糖尿病的一种有前景的治疗选择。然而，目前2型糖尿病的治疗指南和治疗算法要么忽视要么低估了代谢手术的潜力。在我看来，在2型糖尿病和肥胖的治疗中应更早地考虑代谢手术，而不应再将其视为肥胖相关2型糖尿病患者的最后治疗选择。
