Maleckas A, Venclauskas L, Wallenius V, Lönroth H, Fändriks L
Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Scand J Surg. 2015 Mar;104(1):40-7. doi: 10.1177/1457496914561140. Epub 2015 Jan 26.
The prevalence of diabetes is increasing worldwide, and most of the cases are type 2 diabetes mellitus. The relationship between type 2 diabetes mellitus and obesity is well established, and surgical treatment is widely used for obese patients with type 2 diabetes mellitus. The aim was to present current knowledge about the possible mechanisms responsible for glucose control after surgical procedures and to review the surgical treatment results.
Medical literature was searched for the articles presenting the impact of surgical treatment on glycemic control, long-term results, and possible mechanisms of action among obese individuals with type 2 diabetes mellitus.
Remission of type 2 diabetes mellitus after bariatric surgery depends on the definition of the remission used. Complete remission rate after surgery with the new criteria is lower than was considered before. Randomized controlled studies demonstrate that surgery is superior to best medical treatment for the patients with type 2 diabetes mellitus. The recurrence of type 2 diabetes mellitus after bariatric surgery is observed in up to 40% of cases with ≥ 5 years of follow-up. Despite the recurrence of type 2 diabetes mellitus in this group, better glycemic control and lower risk of macrovascular complications are present. Incretin effects on glycemic control after bariatric surgery are well described, but the role of other possible mechanisms (bile acids, microbiota, intestinal gluconeogenesis) in humans is unclear.
Surgery is an effective treatment of type 2 diabetes mellitus in obese patients. The most optimal surgical procedure for the treatment of obese patients with type 2 diabetes mellitus is still to be established. More research is needed to explore the mechanisms of glycemic control after bariatric surgery.
糖尿病在全球的患病率正在上升，且大多数病例为2型糖尿病。2型糖尿病与肥胖之间的关系已得到充分证实，手术治疗广泛应用于肥胖的2型糖尿病患者。目的是介绍有关手术治疗后血糖控制的可能机制的现有知识，并综述手术治疗结果。
检索医学文献，查找有关手术治疗对2型糖尿病肥胖个体血糖控制的影响、长期结果及可能作用机制的文章。
减重手术后2型糖尿病的缓解取决于所采用的缓解定义。采用新标准手术后的完全缓解率低于之前所认为的。随机对照研究表明，对于2型糖尿病患者，手术优于最佳药物治疗。在随访≥5年的病例中，高达40%的患者在减重手术后出现2型糖尿病复发。尽管该组出现2型糖尿病复发，但血糖控制更好，大血管并发症风险更低。关于减重手术后肠促胰岛素对血糖控制的作用已有充分描述，但其他可能机制（胆汁酸、微生物群、肠道糖异生）在人体中的作用尚不清楚。
手术是肥胖患者2型糖尿病的有效治疗方法。治疗肥胖的2型糖尿病患者的最优化手术方式仍有待确定。需要更多研究来探索减重手术后血糖控制的机制。
