Stefater M A, Inge T H
Division of Endocrinology, Boston Children's Hospital, Endocrinology CLS160.4 BCH3151, 300 Longwood Ave., Boston, MA, 02115, USA.
Department of Surgery, Children's Hospital Colorado, 13123 East 16th Avenue, Box 323, Aurora, CO, 80045-7106, USA.
Curr Diab Rep. 2017 Aug;17(8):62. doi: 10.1007/s11892-017-0887-y.
Type 2 diabetes (T2D) is a growing public health problem in youth, but conventional treatments are often insufficient to treat this disease and its comorbidities. We review evidence supporting an emerging role for bariatric surgery as a treatment for adolescent T2D.
Paralleling what has been seen in adult patients, bariatric surgery dramatically improves glycemic control in patients with T2D. In fact, remission of T2D has been observed in as many as 95-100% of adolescents with diabetes after bariatric surgery, particularly vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) surgery. This striking outcome may be due to both weight-dependent- and weight-independent factors, and recent studies suggest that T2D-related comorbidities may also improve after surgery. Bariatric surgery including RYGB and VSG is a powerful therapeutic option for obese adolescents with T2D. Benefits must be weighed against risk for postoperative complications such as nutritional deficiencies, but earlier surgical intervention might lead to more complete metabolic remission in obese patients with T2D.
2型糖尿病(T2D)在青少年中已成为一个日益严重的公共卫生问题,但传统治疗方法往往不足以治疗该疾病及其合并症。我们综述了支持减重手术作为青少年T2D治疗方法的新证据。
与成年患者的情况类似,减重手术能显著改善T2D患者的血糖控制。事实上,在接受减重手术后,多达95%-100%的青少年糖尿病患者实现了T2D缓解,尤其是接受垂直袖状胃切除术(VSG)和Roux-en-Y胃旁路术(RYGB)的患者。这一显著结果可能归因于体重依赖性和非体重依赖性因素,并且最近的研究表明,术后T2D相关合并症也可能得到改善。包括RYGB和VSG在内的减重手术是肥胖青少年T2D的一种有效治疗选择。必须权衡手术益处与术后并发症(如营养缺乏)风险,但早期手术干预可能会使肥胖T2D患者实现更完全的代谢缓解。