Chondronikola M, Harris L L S, Klein S
Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, Washington University School of Medicine, St Louis, MO, USA.
Department of Nutritional Sciences and Dietetics, Harokopio University of Athens, Athens, Greece.
J Intern Med. 2016 Nov;280(5):476-486. doi: 10.1111/joim.12527. Epub 2016 Oct 14.
Type 2 diabetes (T2D) is a major worldwide public health concern. Despite a large armamentarium of T2D medications, a large proportion of patients fail to achieve recommended treatment goals for glycemic control. Weight loss has profound beneficial effects on the metabolic abnormalities involved in the pathogenesis of T2D. Accordingly, bariatric surgery, which is the most effective available weight loss therapy, is also the most effective therapy for treating patients with T2D. Surgical procedures that bypass the upper gastrointestinal (UGI) tract are particularly effective in achieving partial and even complete remission of T2D, suggesting that UGI bypass has weight loss-independent effects on glycemic control. Although a number of hypotheses (e.g. a role for multiorgan insulin sensitivity, β-cell function, incretin response, the gut microbiome, bile acid metabolism, intestinal glucose metabolism and browning of adipose tissue) have been proposed to explain the potential unique effects of UGI tract bypass surgery, none has yet been adequately evaluated to determine therapeutic importance in patients with T2D. Here, we review the efficacy of UGI bypass surgery in treating T2D and the mechanisms that have been proposed to explain its potential weight loss-independent therapeutic effects.
2型糖尿病（T2D）是全球主要的公共卫生问题。尽管有大量治疗T2D的药物，但很大一部分患者未能达到推荐的血糖控制治疗目标。体重减轻对T2D发病机制中涉及的代谢异常具有深远的有益影响。因此，减肥手术作为最有效的减肥疗法，也是治疗T2D患者最有效的疗法。绕过上消化道（UGI）的手术程序在实现T2D的部分甚至完全缓解方面特别有效，这表明UGI旁路对血糖控制具有独立于体重减轻的作用。尽管已经提出了许多假设（例如多器官胰岛素敏感性、β细胞功能、肠促胰岛素反应、肠道微生物群、胆汁酸代谢、肠道葡萄糖代谢和脂肪组织褐变的作用）来解释UGI旁路手术的潜在独特作用，但尚未对其进行充分评估以确定在T2D患者中的治疗重要性。在这里，我们回顾了UGI旁路手术治疗T2D的疗效以及已提出的解释其潜在独立于体重减轻的治疗作用的机制。
