Can Roux-en-Y gastric bypass provide a lifelong solution for diabetes mellitus?

摘要: Diabetes mellitus is the most common endocrine disorder, currently affecting more than 170 million people worldwide and prospectively 365 in year 2030.1 Surgical treatment of diabetes form pancreatic transplantation has emerged as single effective means achieving normal glucose homeostasis this patient population.2 Since first successful pancreas performed 1966, there been considerable progress field,3 notable being combined pancreas–kidney transplantation, which was reported 1967.4 The shortage organs available for rejection adverse effects associated with immune suppression have shown to limit wide clinical application treat patients diabetes. Thus, type 1 no choice but continue insulin therapy. Although recent advances islets success Edmonton group (a small series 7 patients) are encouraging diabetic patients, complexity technique problems could its benefit.5,6 Similarly, 2 successfully controlled gastric bypass surgery morbidly obese patients; considered be breakthrough surgical diabetes. Several classes antidiabetic agents, including analogs (e.g., glucagon-like peptide-1 [GLP-1] receptor agonists such exenatide) use either monotherapies or combination improve glycemic control diabetes.7 However, failure these medications address all pathophysiological defects frequently during course disease. Friedman colleagues8 1955 evidence that (subtotal gastrectomy) improved conditions patients. This finding received little attention until almost 30 years later. One study published 1982 suggested massive weight loss after accompanied by an improvement number, basal hyperinsulinemia tolerance.9 In 1984, Hughes colleagues10 concluded studying 6 control. Furthermore, a report 1992 severely bypass.11 Many subsequent studies high controlling rates ranging from 76.5% 97.0%.12 randomized trials needed verify effectiveness on nonobese diabetes, potential change current concepts pathophysiology and, possibly, management disease.13 very support further needed. Based prevalence fact promising option, we sought explore theoretical applicability