Kassem Mahmoud Attia Mohamed, Durda Michael Andrew, Stoicea Nicoleta, Cavus Omer, Sahin Levent, Rogers Barbara
Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
Front Endocrinol (Lausanne). 2017 Mar 1;8:37. doi: 10.3389/fendo.2017.00037. eCollection 2017.
Recent studies discussed the benefit of bariatric surgery on obese patients diagnosed with type 2 diabetes mellitus (T2DM). Several factors play an essential role in predicting the impact of bariatric surgery on T2DM, such as ABCD score (age, BMI, C-peptide, and duration of the disease), HbA1c, and fasting blood glucose, incretins [glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP)]. DiaRem score known to include factors such as age, HbA1c, medication, and insulin usage used to predict the remission of T2DM, but it has some limitations. An extensive literature search was conducted on PubMed and Google Scholar using keywords such as gastric bypass, T2DM, bariatric surgery, GLP-1, GIP, and post bariatric hypoglycemia. Restrictive-malabsorptive procedures are most effective in treating T2DM patients based on changes induced in appetite through regulation of gastrointestinal hormones, with decreased hunger and increased satiation. We provide a review of bariatric surgery influence on T2DM and management of post-intervention hypoglycemic events. Post-bariatric surgery hypoglycemia is a serious complication especially when patients develop life-threatening neuroglycopenia with loss of consciousness and seizure. The avoidance of this adverse event may be achieved by strict dietary modification including a restriction on carbohydrates as well as foods with high glycemic index. Further research will provide more information on post-bariatric surgery hyperinsulinemic hypoglycemia pathophysiology and management.
近期研究探讨了减重手术对诊断为2型糖尿病（T2DM）的肥胖患者的益处。几个因素在预测减重手术对T2DM的影响中起着至关重要的作用，如ABCD评分（年龄、体重指数、C肽和病程）、糖化血红蛋白（HbA1c）、空腹血糖、肠促胰岛素[胰高血糖素样肽-1（GLP-1）和胃抑制肽（GIP）]。已知DiaRem评分包括年龄、HbA1c、用药情况和胰岛素使用情况等因素，用于预测T2DM的缓解，但它有一些局限性。在PubMed和谷歌学术上使用“胃旁路术”“T2DM”“减重手术”“GLP-1”“GIP”和“减重术后低血糖症”等关键词进行了广泛的文献检索。基于通过调节胃肠激素引起的食欲变化，限制-吸收不良手术在治疗T2DM患者方面最为有效，可减少饥饿感并增加饱腹感。我们综述了减重手术对T2DM的影响以及干预后低血糖事件的管理。减重术后低血糖症是一种严重的并发症，尤其是当患者出现危及生命的神经低血糖症，伴有意识丧失和癫痫发作时。通过严格的饮食调整，包括限制碳水化合物以及高血糖指数的食物，可避免这一不良事件。进一步的研究将提供更多关于减重术后高胰岛素血症性低血糖症病理生理学和管理的信息。
