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Review of multimodal treatment for type 2 diabetes: combining metabolic surgery and pharmacotherapy

机译：2型糖尿病多式化治疗方法：结合代谢外科和药物治疗

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Treating type 2 diabetes mellitus (T2DM) in patients with obesity remains a challenge for physicians, endocrinologists and surgeons, a fact supported by uncontroverted evidence from studies looking at mortality and associated morbidity. Metabolic surgery remains the most effective treatment for obesity and T2DM with evidence demonstrating an improvement or resolution of symptoms of T2DM and a reduction in a mortality and rates of cardiovascular events compared with pharmacotherapy alone. While these results are promising, two important limitations must be recognized and addressed. With regards to long-term remission of T2DM, the metabolic benefits of bariatric surgery appear to fatigue with time and a proportion of patients will not maintain normoglycaemia without pharmacotherapy. Second, there has been noteworthy progress in the development of several classes of medications for the treatment of T2DM which were unavailable when the original studies comparing the effects of bariatric surgery with pharmacotherapy were conducted. Recognizing the need for further treatment following metabolic surgery for long-term disease control in conjunction with the availability of newer medications offering more effective, nonsurgical treatment presents a critical turning point in treatment treating obesity. While the traditional approach would be to determine the superiority (or non-inferiority) of these agents compared with surgery, clinicians and surgeons must acknowledge the limitations of this attitude towards treatment given evidence from fields such as cancer, where a combinational approach is the gold standard. Recent advances in pharmacotherapy, present not only a novel approach to medical therapy but a renewed impetus to investigate what can be achieved through multimodal care.
机译：治疗肥胖患者的2型糖尿病（T2DM）对于医生，内分泌学家和外科医生来说仍然是一个挑战，该事实是来自研究死亡率和相关发病率的研究的无限证据支持。代谢外科仍然是肥胖和T2DM的最有效的治疗方法，证据证明了与单独的药物治疗相比，对T2DM的症状和降低的死亡率和心血管事件的率降低。虽然这些结果很有希望，但必须确认和解决两个重要限制。关于T2DM的长期缓解，畜分手术的代谢益处似乎随着时间的推移而疲劳，并且一部分患者不会在没有药物治疗的情况下保持正常性血症。其次，在进行比较肥胖症手术与药物疗法的原始研究时，在治疗T2DM的几类药物的发展方面存在值得注意的进展。认识到在长期疾病控制后进行进一步治疗的需要与新的药物提供更有效的可用性，非必要的治疗方法呈现治疗肥胖症的关键转折点。虽然传统方法是与手术相比，临床医生和外科医生确定这些药剂的优越性（或非劣势），临床医生和外科医生必须承认这种态度对治疗的局限性给出了癌症等领域的证据，其中组合方法是金标准。药物治疗的最新进展不仅提出了一种新的医疗疗法方法，而且还提高了调查通过多式化护理可以实现的内容的推动力。

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