Division of Minimally Invasive and Gastrointestinal Surgery, The Medical College of Wisconsin, United States.
Division of Minimally Invasive and Gastrointestinal Surgery, The Medical College of Wisconsin, United States.
Diabetes Res Clin Pract. 2023 May;199:110667. doi: 10.1016/j.diabres.2023.110667. Epub 2023 Apr 8.
Diabetes mellitus is one of the major epidemics in the United States. It is heavily associated with obesity and multiple metabolic derangements that lead to long term morbidity, mortality as well as financial burden. Although medical therapy has been the mainstay in the management of diabetes mellitus, there remains a large portion of this patient population which struggles to obtain adequate glycemic control and long-term weight control with medical management alone. Bariatric surgery is a powerful tool in combating diabetes mellitus and affects glucose homeostasis through a variety of pathways. While it does provide a durable pathway for weight loss, improvement in glucose homeostasis is not only affected by the weight loss seen after bariatric surgery. Changes in gut hormone secretion, insulin regulation, and gut microbial composition also affect how these operations improve glucose homeostasis. Through improvement in the management of diabetes mellitus, comorbidities including cardiovascular disease, in turn demonstrate improvement. In this article, we will discuss the role of bariatric (metabolic) surgery as it relates to long term weight loss and the impact that weight loss has on improvement in diabetes mellitus.
糖尿病在美国是一种主要的流行病。它与肥胖和多种代谢紊乱密切相关，导致长期发病率、死亡率以及经济负担。尽管医学治疗一直是糖尿病管理的主要方法，但仍有很大一部分患者群体仅通过医学管理难以获得足够的血糖控制和长期体重控制。减重手术是治疗糖尿病的有力工具，通过多种途径影响葡萄糖稳态。虽然它确实为减肥提供了持久的途径，但葡萄糖稳态的改善不仅受到减重手术后体重减轻的影响。肠道激素分泌、胰岛素调节和肠道微生物组成的变化也会影响这些手术如何改善葡萄糖稳态。通过改善糖尿病的管理，包括心血管疾病在内的合并症也随之得到改善。在本文中，我们将讨论减重（代谢）手术在长期减肥方面的作用，以及减肥对改善糖尿病的影响。
