An update on the role of bariatric surgery in diabetes management

作者：Malkani Samir

来源：Current Opinion in Endocrinology Diabetes and Obesity, 2015, 22(2): 98-105.

DOI：10.1097/MED.0000000000000143

• bariatric surgery
• diabetes remission
• glucose metabolism
• gut hormones
• obesity

Purpose of review
To review the current state of knowledge on the effects of weight loss (bariatric) surgical procedures in individuals with type 2 diabetes.
Recent findings
Observational and randomized studies provide robust data on the efficacy of bariatric surgery for weight loss and improvement in hyperglycemia. Follow-up information up to 20 years is now available. Surgery offers similar benefits in individuals with BMI 30-35, compared with those with higher BMI. There a is better understanding of the role of gut hormones and nonhormonal factors on weight loss and glucose metabolism. Preoperative factors that predict favorable surgical outcomes have been identified.
Summary
Of commonly performed procedures, adjustable gastric banding has the lowest efficacy for weight loss and diabetes remission and a higher complication rate. Roux-en-Y gastric bypass and sleeve gastrectomy are comparable in terms of efficacy and complications. Remission rates for diabetes range between 40 and 80%; randomized trials show slightly lower remission rates compared with observational studies. At 20 years, approximately 50% of remitters have relapse of diabetes. Complex gut hormonal changes, caloric restriction, and other intestinal factors form the basis for metabolic effects of surgery. Better preoperative beta-cell function is the strongest predictor for remission. Long-term follow-up data is still sparse.

• 出版日期2015-4