Division of Endocrinology, Landstuhl Regional Medical Center, US Army, Landstuhl, Germany.
Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
Curr Diab Rep. 2019 Nov 4;19(11):112. doi: 10.1007/s11892-019-1242-2.
The number of bariatric surgeries for patients with type 1 or type 2 diabetes continues to grow. Clinicians are challenged to choose therapies that reach glycemic targets without inducing adverse effects in post-bariatric patients without published guidelines. This review evaluates data supporting the best strategies for diabetes management in patients undergoing bariatric surgery.
Though few clinical trials have evaluated the safety and effectiveness of different glucose-lowering therapies following bariatric surgery, remission of diabetes or reduced medications is an established benefit of bariatric surgery. Adverse events including diabetic ketoacidosis in post-bariatric patients on sodium-glucose co-transporter 2 (SGLT2) inhibitors or inadequate insulin have been reported in patient's with both type 1 and type 2 diabetes. Metformin, glucagon-like peptide-1 (GLP-1) agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, SGLT2 inhibitors, insulin, and sulfonylureas have been used successfully in the perioperative period for other surgeries and guidelines recommend adjusting the doses of these medications especially in the perioperative period. Clinicians should favor weight-neutral or weight-loss promoting therapies in post-bariatric surgery patients such as medical nutrition therapy, metformin, GLP-1 agonists, SGLT2 inhibitors, and DPP-4 inhibitors.
治疗 1 型或 2 型糖尿病患者的减重手术数量持续增长。临床医生面临的挑战是选择既能达到血糖目标又不会在没有发表指南的情况下对减重手术后的患者产生不良反应的治疗方法。本综述评估了支持在接受减重手术的患者中管理糖尿病的最佳策略的数据。
尽管很少有临床试验评估了减重手术后不同降血糖治疗的安全性和有效性，但减重手术可使糖尿病缓解或减少药物使用，这是其已被证实的益处。在 1 型和 2 型糖尿病患者中，已有报道称，接受钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂或胰岛素不足的减重后患者会出现糖尿病酮症酸中毒等不良事件。在其他手术的围手术期，已成功使用了二甲双胍、胰高血糖素样肽-1（GLP-1）激动剂、二肽基肽酶-4（DPP-4）抑制剂、SGLT2 抑制剂、胰岛素和磺酰脲类药物，并且指南建议特别在围手术期调整这些药物的剂量。临床医生应在减重手术后的患者中优先选择体重中性或促进体重减轻的治疗方法，如医学营养疗法、二甲双胍、GLP-1 激动剂、SGLT2 抑制剂和 DPP-4 抑制剂。
