The many faces of diabetes. Is there a need for re-classification? A narrative review

BMC Endocrine Disorders

Rishi Singhal¹  Radwan Kassir²  Tadeja Pintar³  Zoë E. Kooreman⁴  Dharmanand Ramnarain⁵  Sjaak Pouwels⁶  Wah Yang⁷  Nasser Sakran⁸  Chetan Parmar⁹  Edith M. Willigendael^1,10  Brijesh Madhok^1,11  Kamal Mahawar^1,12  Yitka Graham^1,13 

[1] Bariatric and Upper GI Unit, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK;CHU Félix Guyon, Allée des Topazes, Saint-Denis, France;Department of Abdominal Surgery, University Medical Center Ljubljana, Zaloška cesta, Ljubljana, Slovenia;Department of Dermatology, Amphia Hospital, Breda, The Netherlands;Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands;Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands;Department of Intensive Care Medicine, ETZ Elisabeth, P.O. Box 90151, Hilvarenbeekseweg 60, 5000 LC, Tilburg, The Netherlands;Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, 613 Huangpu Avenue West, Guangzhou, Guangdong Province, China;Department of Surgery, Holy Family Hospital, Nazareth, Israel;the Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel;Department of Surgery, Whittington Health NHS Trust, London, UK;Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands;East Midlands Bariatric and Metabolic Institute, University Hospital of Derby and Burton NHS Foundation Trust, Burton, UK;Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK;Bariatric Unit, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK;Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK;Facultad de Psycologia, Universidad Anahuac Mexico, Mexico City, Mexico;

关键词: Diabetes mellitus;    Bariatric surgery;    Antidiabetic drugs;    Gastrointestinal hormones;    Metabolic surgery;    Classification;   

DOI  :  10.1186/s12902-021-00927-y

来源: Springer

【 摘 要 】

The alarming rise in the worldwide prevalence of obesity and associated type 2 diabetes mellitus (T2DM) have reached epidemic portions. Diabetes in its many forms and T2DM have different physiological backgrounds and are difficult to classify. Bariatric surgery (BS) is considered the most effective treatment for obesity in terms of weight loss and comorbidity resolution, improves diabetes, and has been proven superior to medical management for the treatment of diabetes. The term metabolic surgery (MS) describes bariatric surgical procedures used primarily to treat T2DM and related metabolic conditions. MS is the most effective means of obtaining substantial and durable weight loss in individuals with obesity. Originally, BS was used as an alternative weight-loss therapy for patients with severe obesity, but clinical data revealed its metabolic benefits in patients with T2DM. MS is more effective than lifestyle or medical management in achieving glycaemic control, sustained weight loss, and reducing diabetes comorbidities. New guidelines for T2DM expand the use of MS to patients with a lower body mass index.Evidence has shown that endocrine changes resulting from BS translate into metabolic benefits that improve the comorbid conditions associated with obesity, such as hypertension, dyslipidemia, and T2DM. Other changes include bacterial flora rearrangement, bile acids secretion, and adipose tissue effect.This review aims to examine the physiological mechanisms in diabetes, risks for complications, the effects of bariatric and metabolic surgery and will shed light on whether diabetes should be reclassified.

【 授权许可】

CC BY