The role of bariatric surgery to treat diabetes: current challenges and perspectives.

摘要: Bariatric surgery is emerging as a powerful weapon against severe obesity and type 2 diabetes mellitus (T2DM). Given its role in metabolic regulation, the gastrointestinal tract constitutes meaningful target to treat T2DM, especially light of accumulating evidence that with manipulations may result T2DM remission (metabolic surgery). The major mechanisms mediating weight loss-independent effects bariatric comprise on tissue-specific insulin sensitivity, β-cell function incretin responses, changes bile acid composition flow, modifications gut microbiota, intestinal glucose metabolism increased brown adipose tissue activity. Shorter duration, better preoperative glycemic control profound loss, have been associated higher rates lower risk relapse. In short medium term, significant amount lost, completely regress, cardiometabolic factors are dramatically improved. long achieve durable prevent cancer, improve overall while leading remission, reduce total cause-specific mortality. gradient efficacy for loss comparing four established surgical procedures biliopancreatic diversion >Roux-en-Y gastric bypass >sleeve gastrectomy >laparoscopic adjustable banding. According recently released guidelines, should be recommended diabetic patients class III obesity, regardless their level control, II inadequately controlled despite lifestyle optimal medical therapy. Surgery also considered I hyperglycemia treatment.