Bariatric Surgery in the Treatment of Type 2 Diabetes.

Bariatric Surgery in the Treatment of Type 2 Diabetes.
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DOI:
10.1007/s11892-019-1269-4
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发表时间:
2019-12-04
影响因子:
4.2
通讯作者:
Kraftson AT
Kraftson AT
中科院分区:
医学2区
文献类型:
--
作者:
Affinati AH;Esfandiari NH;Oral EA;Kraftson AT

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我们试图通过回顾减肥手术的历史,检查临床数据,探索假定的作用机制,并预测其未来来描述减肥手术对糖尿病的影响。临床试验的结果表明,减肥手术在治疗后1年时诱导33-90%的个体的糖尿病缓解,而药物治疗的个体为0-39%。缓解率随着时间的推移而下降,但在手术治疗的个体中仍然较高。研究已经揭示了手术的许多作用,包括对肠道生理学、神经元信号传导、肠促胰岛素激素分泌、胆汁酸代谢和微生物组变化的影响。减肥手术通过体重依赖和体重无关的作用改善了糖尿病的控制。这些不同的机制有助于解释手术治疗与药物治疗之间的差异。他们还解释了各种减肥手术类型的不同效果。了解手术如何影响糖尿病将有助于优化疾病预防和治疗的治疗利用。
We seek to characterize the impact of bariatric surgery on diabetes mellitus by recalling its history, examining the clinical data, exploring the putative mechanisms of action, and anticipating its future. Results of clinical trials reveal that bariatric surgery induces remission of diabetes in 33–90% of individuals at 1-year post-treatment versus 0–39% of medically managed. Remission rates decrease over time but remain higher in surgically treated individuals. Investigations have revealed numerous actions of surgery including effects on intestinal physiology, neuronal signaling, incretin hormone secretion, bile acid metabolism, and microbiome changes. Bariatric surgery improves control of diabetes through both weight-dependent and weight-independent actions. These various mechanisms help explain the difference between individuals treated surgically vs. medically. They also explain differing effects of various bariatric surgery procedure types. Understanding how surgery affects diabetes will help optimize utilization of the therapy for both disease prevention and treatment.
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