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最新-2021-美國ADA糖尿病醫療指引(Standards of Medical Care in Diabetes-2021)已經公布嘍！其中：肥胖管理用於2型糖尿病的治療：糖尿病的醫療標準2021年(Obesity Management for the Treatment of Type 2 Diabetes: Standards of Medical Care in Diabetes—2021)
內文中對於【糖尿病患者-代謝外科手術】有詳細的建議：
『現在已經積累了大量的證據，包括來自眾多隨機對照（非盲）臨床試驗的數據，證明與各種生活方式/醫學方法相比，#代謝外科手術能夠更好地控制第2型糖尿病和肥胖患者的血糖控制並降低心血管危險因素干預。僅在非隨機觀察性研究中才觀察到糖尿病，心血管疾病和癌症的微血管並發症有所改善。隊列研究試圖匹配手術和非手術科目表明，該過程可能會降低長期死亡率。』
所以『代謝外科手術』將有助於第2型糖尿病和肥胖患者的血糖控制並降低心血管危險。但建議要施作代謝外科手術前，一定要諮詢專業的醫療團隊唷！
彰化基督教醫院 國際減重暨形體美容中心 『代謝外科手術』諮詢快速通道：https://reurl.cc/odKXZQ
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----ADA對於代謝外科手術建議原文----
Metabolic Surgery
Recommendations
8.16 Metabolic surgery should be a recommended option to treat type 2 diabetes in screened surgical candidates with BMI ≥40 kg/m2 (BMI ≥37.5 kg/m2 in Asian Americans) and in adults with BMI 35.0–39.9 kg/m2 (32.5–37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods. A
8.17 Metabolic surgery may be considered as an option to treat type 2 diabetes in adults with BMI 30.0–34.9 kg/m2 (27.5–32.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods. A
8.18 Metabolic surgery should be performed in high-volume centers with multidisciplinary teams knowledgeable about and experienced in the management of diabetes and gastrointestinal surgery. E
8.19 Long-term lifestyle support and routine monitoring of micronutrient and nutritional status must be provided to patients after surgery, according to guidelines for postoperative management of metabolic surgery by national and international professional societies. C
8.20 People being considered for metabolic surgery should be evaluated for comorbid psychological conditions and social and situational circumstances that have the potential to interfere with surgery outcomes. B
8.21 People who undergo metabolic surgery should routinely be evaluated to assess the need for ongoing mental health services to help with the adjustment to medical and psychosocial changes after surgery. C
Several gastrointestinal (GI) operations, including partial gastrectomies and bariatric procedures (44), promote dramatic and durable weight loss and improvement of type 2 diabetes in many patients. Given the magnitude and rapidity of the effect of GI surgery on hyperglycemia and experimental evidence that rearrangements of GI anatomy similar to those in some metabolic procedures directly affect glucose homeostasis (45), GI interventions have been suggested as treatments for type 2 diabetes, and in that context they are termed “metabolic surgery.”
A substantial body of evidence has now been accumulated, including data from numerous randomized controlled (nonblinded) clinical trials, demonstrating that metabolic surgery achieves superior glycemic control and reduction of cardiovascular risk factors in patients with type 2 diabetes and obesity compared with various lifestyle/medical interventions (17). Improvements in microvascular complications of diabetes, cardiovascular disease, and cancer have been observed only in nonrandomized observational studies (59–70). Cohort studies attempting to match surgical and nonsurgical subjects suggest that the procedure may reduce longer-term mortality (60,71).
資料來源網址：https://care.diabetesjournals.org/....../Supplement_1/S100
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