Effects of bariatric surgery on glucose homeostasis and type 2 diabetes.
Effects of bariatric surgery on glucose homeostasis and type 2 diabetes.
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DOI：
10.1053/j.gastro.2012.07.114
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发表时间：
2012-10
期刊：
影响因子：
29.4
通讯作者：
Klein S
中科院分区：
文献类型：
--
作者：
Bradley D;Magkos F;Klein S
肥胖是2型糖尿病（T2D）的重要危险因素。减肥可以改善T2D发病的主要因素，即胰岛素作用和β细胞功能，被认为是肥胖T2D患者的主要治疗方法。不幸的是，大多数T2D患者无法通过药物治疗实现成功的减肥和适当的血糖控制。相比之下，减肥手术在大多数患者中引起明显的体重减轻和T2D完全缓解。此外，将营养物质从上胃肠道转移出去的减肥外科手术比单纯限制胃容量的手术更能成功地减轻体重和缓解T2D。虽然上消化道旁路手术通过增加餐后早期胰高血糖素样肽1和胰岛素的血浆浓度改变了对膳食摄入的代谢反应，但尚不清楚这些影响是否对手术引起的体重减轻后血糖和T2D的长期控制有重要贡献。尽管如此，手术对体重和代谢功能的影响表明，减肥手术应该成为T2D标准治疗的一部分。需要更多的研究来加深我们对不同减肥手术的生理影响的理解，以及可能的减肥无关因素，这些因素可以改善代谢功能并有助于解决T2D。
Obesity is an important risk factor for type 2 diabetes (T2D). Weight loss improves the major factors involved in the pathogenesis of T2D, namely insulin action and β-cell function, and is considered a primary therapy for obese patients who have T2D. Unfortunately, most patients with T2D fail to achieve successful weight loss and adequate glycemic control from medical therapy. In contrast, bariatric surgery causes marked weight loss and complete remission of T2D in most patients. Moreover, bariatric surgical procedures that divert nutrients away from the upper gastrointestinal tract are more successful in producing weight loss and remission of T2D than those that simply restrict stomach capacity. Although upper gastrointestinal tract bypass procedures alter the metabolic response to meal ingestion, by increasing early post-prandial plasma concentrations of glucagon-like peptide 1 and insulin, it is not clear whether these effects make an important contribution to long-term control of glycemia and T2D once substantial surgery-induced weight loss has occurred. Nonetheless, the effects of surgery on body weight and metabolic function indicate that bariatric surgery should be part of the standard therapy for T2D. More research is needed to advance our understanding of the physiological effects of different bariatric surgical procedures and possible weight loss-independent factors that improve metabolic function and contribute to the resolution of T2D.