Diabetes Care：减重/代谢手术治疗BMI低于35的2型糖尿病患者

2016-05-26 liyue 译 MedSci原创

减重手术在过去25年主要被用于BMI≥35kg/m2的患者。然而目前有较强证据表明减重手术可以明显改善或导致2型糖尿病缓解，部分机制是与体重无关的，并且基线水平的BMI不能预测手术带来的血糖或心血管方面的获益。这促使人们考虑将这一“代谢手术”应用到2型糖尿病的治疗上，包括那些BMI<35kg/m2的患者，他们是糖尿病患者的主要组成部分。一个涵盖了11个随机临床试验（RCT）的meta分析比较

减重手术在过去25年主要被用于BMI≥35kg/m2的患者。然而目前有较强证据表明减重手术可以明显改善或导致2型糖尿病缓解，部分机制是与体重无关的，并且基线水平的BMI不能预测手术带来的血糖或心血管方面的获益。这促使人们考虑将这一“代谢手术”应用到2型糖尿病的治疗上，包括那些BMI<35kg/m2的患者，他们是糖尿病患者的主要组成部分。

一个涵盖了11个随机临床试验（RCT）的meta分析比较了减重/代谢手术与药物/生活方式治疗的2型糖尿病患者，1A级证据表明手术治疗在2型糖尿病的缓解、血糖控制、HbA1c降低等方面均优于后者。

重要的是，在基线BMI较低或<35kg/m2的患者中也是如此。还有一些高质量、非随机、前瞻性的meta分析也得到了相似的结论。所有相关的meta分析表明，无论是BMI高于或低于35的2型糖尿病患者，他们减重手术后糖尿病的缓解情况都是具有可比性的。减重手术在安全性、抗糖尿病的持久性以及在心血管方面的获益等方面，在BMI低于和高于35的患者中也基本一致。目前还需要更多RCT长期研究、分析有关严重大血管和微血管事件的结局和死亡率。

现有证据，包括众多RCT的1级证据，都支持第二届糖尿病手术峰会考虑将减重/代谢手术治疗BMI<35kg/m2的2型糖尿病与改变生活方式、药物治疗等一同作为新的指南。

原始出处：

Cummings DE,Cohen RV.Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI<35kg/m2.Diabetes Care 2016 Jun; 39(6): 924-933.

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2016-12-22 贵阳

#代谢手术#

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2016-12-01 ms9608593228839890

#DIA#

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2017-01-23 ms5439512287675881

#BET#

35 0
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2016-09-28 木头人513

#Diabetes#

30 0
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2016-06-02 沉心多思

好文章，得多学习了！

72 0
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2016-05-28 lixiaol

#手术治疗#

38 0
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2016-05-28 aids213

#2型糖尿病患者#

31 0
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2016-05-28 xue8604

#糖尿病患者#

27 0

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Diabetes Care：减重/代谢手术治疗BMI低于35的2型糖尿病患者

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