減重手術在肥胖第2型糖尿病治療的角色

The Role of Bariatric Surgery in the Management of Obese Type 2 Diabetes Mellitus

游慧宜(Hui-I Yu)

《內科學誌》 23卷3期 (2012/06) Pp. 166-172

https://doi.org/10.6314/JIMT.2012.23(3).03

摘要

The prevalence of type 2 diabetes mellitus (type 2 DM) has been increasing steadily as obesity became a worldwide epidemic. Though lifestyle modification, which includes weight reduction is a proven and cost-effective modality in the treatment in type 2 DM, it is often hard to sustain. Numerous studies have demonstrated that bariatric surgery is an effective alternative treatment in achieving body weight reduction and reducing mortality in selected patients. Pories was the one who first showed that bariatric surgery can improve type 2 DM. He showed that there is a remission rate of 83% in type 2 DM with bariatric surgery. Later meta-analysis also showed a diabetes remission rate of 78% after the bariatric surgery, which overall stays at 62% of DM remission after a two-year follow up. The probability of remission is related to the method of surgery, duration of diabetes, and control status etc. Besides, intestine hormone (incretin) had role in diabetes remission. Bariatric surgery is effective both in improving DM status and decreased mortality, which carries a low risk of surgery and argues strongly on cost-effective analysis. However, the possible long-term complications including deficiencies of minerals, ferrous and other nutrients need to be addressed.

關鍵字

減重手術 ； 第2型糖尿病 ； 肥胖

並列摘要

The prevalence of type 2 diabetes mellitus (type 2 DM) has been increasing steadily as obesity became a worldwide epidemic. Though lifestyle modification, which includes weight reduction is a proven and cost-effective modality in the treatment in type 2 DM, it is often hard to sustain. Numerous studies have demonstrated that bariatric surgery is an effective alternative treatment in achieving body weight reduction and reducing mortality in selected patients. Pories was the one who first showed that bariatric surgery can improve type 2 DM. He showed that there is a remission rate of 83% in type 2 DM with bariatric surgery. Later meta-analysis also showed a diabetes remission rate of 78% after the bariatric surgery, which overall stays at 62% of DM remission after a two-year follow up. The probability of remission is related to the method of surgery, duration of diabetes, and control status etc. Besides, intestine hormone (incretin) had role in diabetes remission. Bariatric surgery is effective both in improving DM status and decreased mortality, which carries a low risk of surgery and argues strongly on cost-effective analysis. However, the possible long-term complications including deficiencies of minerals, ferrous and other nutrients need to be addressed.

並列關鍵字

Bariatric surgery ； Type 2 diabetes mellitus ； Obesity