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Diabetesremission durch metabolische Chirurgie

Diabetes remission after metabolic surgery

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Zusammenfassung

Es besteht kein Zweifel, dass die metabolische Chirurgie eine sehr effektive therapeutische Option bei morbid adipösen Patienten mit Typ-2-Diabetes und einem „Body Mass Index“ (BMI) >45 kg/m2 darstellt, insbesondere dann, wenn die Diabetesdauer kurz ist und die Hyperinsulinämie und die Insulinresistenz sehr ausgeprägt sind. Bei Patienten mit einem niedrigeren BMI-Ausgangswert sind die Ergebnisse weitaus weniger beeindruckend, wobei dies darauf zurückzuführen sein könnte, dass bei diesen Patienten der Insulinmangel schon ausgeprägter ist und die hochgradige Insulinresistenz weniger dominierend. Ob die akute „Heilung“ tatsächlich langfristig fortbesteht und tatsächlich zu einer verminderten kardiovaskulären Morbidität und Mortalität führt und auch die Krebsmortalität bei Patienten mit Typ-2-Diabetes langfristig reduzieren kann, ist Gegenstand laufender Studien. Gegenwärtig sind noch viele Fragen offen: Welche Patienten profitieren besonders von der metabolischen Chirurgie? Sind eine längere Diabetesdauer und eine weniger ausgeprägte Adipositas limitierende Faktoren für eine erfolgreiche Rückbildung des Typ-2-Diabetes? Eine vor Kurzem von der Havard-Universität initiierte kontrollierte Studie (http://clinicaltrials.gov/ct2/show/NCT01073020?term=joslin&rank=8) soll klären, ob die gegenwärtig durchgeführten bariatrischen Operationsverfahren multidisziplinären Programmen mit dem Ziel der Lebensstiländerung und Gewichtsreduktion bei Patienten mit Typ-2-Diabetes und weniger ausgeprägter Adipositas (Klasse 1 und 2) tatsächlich überlegen sind.

Abstract

There is no doubt that metabolic surgery represents a highly effective therapeutic option in morbidly obese patients with type-2 diabetes and a BMI over 45 kg/m2, in particular when the diabetes is of short duration and hyperinsulinemia and insulin resistance are severe. Results in patients with lower BMIs are far less impressive, although this could be attributable to the fact that insulin deficiency is already more pronounced and high-grade insulin resistance is less dormant in these patients. Whether such an acute“cure” is indeed maintained and actually leads to reduced cardiovascular morbidity and mortality, as well as a long-term reduction in cancer mortality in type-2 diabetes patients, is the subject of on-going studies. At present, many questions remain open: Which patients profit in particular from metabolic surgery? Do diabetes of long duration and lower adiposity represent limiting factors for successful remission of type-2 diabetes? A controlled study recently initiated by Harvard University (http://clinicaltrials.gov/ct2/show/NCT01073020?term=joslin&rank=8) is designed to establish whether the bariatric surgery currently carried out in the context of multidisciplinary programs aimed at lifestyle changes and weight reduction in type-2 diabetes patients who are less obese (class 1 and 2) is indeed superior.

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Authors and Affiliations

  1. 1. Medizinische Abteilung, Rudolfstiftung Wien, und Abteilung für Angiologie, Universitätsklinik für Innere Medizin 2, Medizinische Universität Wien, Juchgasse 25, 1030, Wien, Österreich

    G. Schernthaner, H.-P. Kopp, J. Brix & G.-H. Schernthaner

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  1. G. Schernthaner
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  2. H.-P. Kopp
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  3. J. Brix
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  4. G.-H. Schernthaner
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Correspondence to G. Schernthaner.

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Schernthaner, G., Kopp, HP., Brix, J. et al. Diabetesremission durch metabolische Chirurgie. Diabetologe 6, 647–655 (2010). https://doi.org/10.1007/s11428-010-0623-6

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