Lee Wei Jei, Aung Lwin
Department of Surgery, Min-Sheng General Hospital, National Taiwan University, Taoyuan, Taiwan.
Department of Surgery, Ng Teng Fong General Hospital, Singapore.
Diabetes Metab J. 2016 Dec;40(6):433-443. doi: 10.4093/dmj.2016.40.6.433.
Type 2 diabetes mellitus (T2DM) is a current global health priority and Asia is the epicenter of this epidemic disease. Unlike in the west, where older population is most affected, the burden of diabetes in Asian countries is disproportionately high in young to middle-age adults. The incidence of diabetic nephropathy is alarmingly high in patients with early onset T2DM, especially in those with poor glycemic control. How to control this chronic and debilitating disease is currently a very important health issue in Asia. Bariatric surgery has proven successful in treating not just obesity but also T2DM in morbid obese patients (body mass index [BMI] >35 kg/m²). Gastrointestinal metabolic surgery recently has been proposed as a new treatment modality for obesity related T2DM for patients with BMI <35 kg/m². Many studies from Asia reported promising results of metabolic surgery to treat obese patients with T2DM which is not well controlled. It has been demonstrated that changes in gastrointestinal hormone secretion after gastrointestinal surgery would favor an early improvement of T2DM in Asians. New procedures have also been designed and proposed specifically for the treatment of diabetes in Asia. This article examines clinical trial data and accepted algorithms with a view toward elucidating the application of metabolic surgery for the treatment of T2DM in the Asia. We propose a systematic approach to surgical treatment, addressing current evidences, patient selection, procedure of choice, and timing and guideline for new procedures.
2型糖尿病（T2DM）是当前全球卫生工作的重点，而亚洲是这种流行病的中心。与西方不同，西方受影响最大的是老年人群体，亚洲国家糖尿病在中青年成年人中的负担却高得不成比例。早发T2DM患者中糖尿病肾病的发病率高得惊人，尤其是血糖控制不佳的患者。如何控制这种慢性衰弱性疾病目前是亚洲一个非常重要的健康问题。减肥手术已被证明不仅对治疗肥胖有效，对病态肥胖患者（体重指数[BMI]>35kg/m²）的T2DM也有效。最近，胃肠代谢手术被提议作为BMI<35kg/m²的肥胖相关T2DM患者的一种新治疗方式。亚洲的许多研究报告了代谢手术治疗T2DM控制不佳的肥胖患者的良好结果。已经证明，胃肠手术后胃肠激素分泌的变化有利于亚洲人T2DM的早期改善。还专门设计并提出了针对亚洲糖尿病治疗的新手术方法。本文研究临床试验数据和公认的算法，以阐明代谢手术在亚洲治疗T2DM的应用。我们提出一种系统的手术治疗方法，涉及当前证据、患者选择、首选手术方法以及新手术方法的时机和指南。
