Esposito Katherine, Maiorino Maria Ida, Petrizzo Michela, Bellastella Giuseppe, Giugliano Dario
Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy,
Endocrine. 2015 Mar;48(2):417-21. doi: 10.1007/s12020-014-0463-z. Epub 2014 Oct 30.
There is mounting evidence that bariatric surgery leads to higher remission rates of type 2 diabetes than any conventional medical treatment, lifestyle intervention, or medically supervised weight loss program. Although remission rates of type 2 diabetes may be as high as 66.7 % after gastric bypass and 28.6 % after gastric band, very few bariatric surgery studies report long-term results with sufficient patient follow-up to minimize biased results. Hence, trials that directly compare bariatric surgery procedures with medical and lifestyle intervention for patients with type 2 diabetes are the best candidate for assessing the role of bariatric surgery in diabetes remission. Three randomized controlled trials and one prospective study have so far been published comparing the effect of Roux-en-Y gastric bypass (RYGB) procedure against optimal medical therapy, with a follow-up ranging from 1 to 6 years: the percentage of diabetic patients in remission (hemoglobin A1C < 6-6.5 % without medications) ranged from 38 to 75 % at the end of follow-up. Intensive lifestyle intervention is also superior to conventional treatment for inducing remission of type 2 diabetes, with remission rates of type 2 diabetes between 10 and 15 % at 1 year of follow-up. Bariatric surgical procedures, especially RYGB, are more effective at inducing initial type 2 diabetes remission in obese patients, but more information is needed about the long-term durability of comorbidity control and complications after bariatric procedures. In the meantime, all efforts should be directed toward primary prevention of type 2 diabetes, given the encouraging results of lifestyle intervention studies.
越来越多的证据表明，与任何传统医学治疗、生活方式干预或医学监督的减肥计划相比，减肥手术能使2型糖尿病的缓解率更高。尽管胃旁路手术后2型糖尿病的缓解率可能高达66.7%，胃束带术后为28.6%，但很少有减肥手术研究报告长期结果，且对患者进行了充分的随访以尽量减少有偏差的结果。因此，直接比较减肥手术与2型糖尿病患者的药物和生活方式干预的试验是评估减肥手术在糖尿病缓解中作用的最佳选择。到目前为止，已经发表了三项随机对照试验和一项前瞻性研究，比较了Roux-en-Y胃旁路术（RYGB）与最佳药物治疗的效果，随访时间为1至6年：随访结束时，糖尿病缓解患者（糖化血红蛋白<6 - 6.5%且未用药）的百分比在38%至75%之间。强化生活方式干预在诱导2型糖尿病缓解方面也优于传统治疗，随访1年时2型糖尿病的缓解率在10%至15%之间。减肥手术，尤其是RYGB，在诱导肥胖患者初始2型糖尿病缓解方面更有效，但需要更多关于减肥手术后合并症控制和并发症长期持续性的信息。与此同时，鉴于生活方式干预研究取得了令人鼓舞的结果，所有努力都应指向2型糖尿病的一级预防。
