Experts say the surgery can provide more than just weight loss. It can also lower the risk of heart attack and stroke.

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减肥手术对糖尿病患者可能是有益的，但是要获得保险来掩盖该手术可能很困难。盖蒂图像

对于肥胖者来说，减肥手术似乎是一种侵入性和危险的选择。

However, recent research shows that people who are obese and have diabetes may benefit from the surgery in more ways than just weight loss and improved blood glucose levels.

减肥手术类型 包括：
  • 胃带
  • gastric bypass
  • 胃袖
  • 胃折叠
  • duodenal switch
  • 无切口手术
  • the Maestro system, which is an implantable device that reduces appetite

研究人员在最近的一项研究中报道说：“在体重减轻手术后的五年内，严重肥胖并且患有糖尿病的人的心脏病发作和中风少40％，死亡人数减少了67％。”

该研究还发现，一个人的手或脚上患有糖尿病神经病的风险降低了50％。

“Macrovascular disease is a leading cause of morbidity and mortality for patients with type 2 diabetes,” explained the researchers, “and medical management, including lifestyle changes, may not be successful at lowering risk.”

然而，最重要的是，特别是经过胃旁路的糖尿病患者中，大约有一半是糖尿病缓解症，由于体重减轻显着和整体健康标记，包括血糖水平，平均七年。

The study, published 在最近的《美国医学协会杂志》（Journal of American Association）中，由美国国家糖尿病和消化研究所和肾脏疾病（NIDDK）资助。

It was researched at four locations: Kaiser Permanente’s Washington, Northern California, and Southern California locations as well as the HealthPartners Institute in Minnesota.

该研究包括5,000多名Kaiser Permanente患者和247名糖尿病患者，患有体重指数（BMI）为35或更高的糖尿病患者，并且接受了减肥手术。

然后将这些患者与15,000人肥胖的对照组形成鲜明对比，并患有糖尿病，他们接受了传统的医疗服务以管理其体重和血糖水平。

“If you tried to duplicate bariatric surgery with medications, it would probably take a minimum of 18 pills,” said Dr. Mitchell Roslin, director of Bariatric and Metabolic Surgery at Lenox Hill Hospital in New York.

罗斯林（Roslin）告雷竞技app官网诉Healthline，减肥手术的好处远不仅仅是减肥。

Roslin解释说：“它可以降低血压，逆转胰岛素抵抗，降低腹部压力，改变性激素的水平，降低胆固醇并改变肠道相互作用。”“肥胖是一种炎症性疾病，减肥手术逆转了这一过程。减肥是部分负责的，但不是完整的故事。神经系统途径和激素水平的变化起着关键作用。它远远超过机械。”

“减肥手术也被称为代谢手术，因为它对缓解代谢性疾病和诸如2型糖尿病等疾病产生了积极影响，”莉莉安·克拉格斯·迪诺（Lillian Craggs-Dino）佛罗里达告诉Healthli雷竞技app官网ne。

她告诉Healthline：“研究表明手术具有积极影响，甚至被接受为治疗选择，并得到美国临床内分泌学家和美国内分泌学会的支持。”雷竞技app官网

克拉格斯·迪诺（Craggs-Dino）补充说，对135项减肥手术研究的大量分析表明，有86％的患者可以显着改善或总缓解2型糖尿病。

克拉格斯·迪诺（Craggs-Dino）警告说：“但是，选择接受体重减轻和糖尿病治疗的手术。”“有一个特定的患者选择过程和跨学科团队的大量术前检查。生活方式的改变，运动和终身维生素和矿物质摄入随访是术后护理的关键部分。”

In 2016, the American Diabetes Association正式认可的减肥手术作为某些2型糖尿病患者的有效治疗方法。

Getting insurance coverage for bariatric surgery isn’t an easy feat.

减肥手术的价格标签不等$ 18,000至$ 35,000，取决于选择的手术类型。

根据美国国立卫生研究院的说法，大约三分之一的2型糖尿病患者在35岁时或以上有合格的BMI，但符合这两个标准不一定足够。

“Private insurers have many restrictions and even exclusions,” explained Roslin. “This is very unfortunate and demonstrates the bias against obese individuals, as few procedures have ever shown benefits equivalent to this study with any medical therapy.”

Without type 2 diabetes, most patients would need to have a BMI greater than 40, according to the NIDDK ，除非他们也患有睡眠呼吸暂停或心脏病。

“Name any procedure that prevents heart attacks, strokes, and deaths, including CABG [coronary artery bypass graft], stents, or carotid endarterectomy,” added Roslin. “They have never approached these results. This data shows that bariatric surgery saves lives in obese diabetics.”

罗斯林因减肥手术缺乏保险范围而感到沮丧，罗斯林（Roslin）指出，医疗系统经常会治疗心脏病或其他症状，同时忽略原因：肥胖症及其相关并发症。

罗斯林说：“这些数据是惊人的，应该排除糖尿病患者非法和不道德的减肥手术。我们需要停止责怪患者肥胖。”

“成功的肥胖病人变得非常结构red,” Roslin said. “They use the procedure and early improvement to make lifestyle changes.”

Roslin added that those who do struggle to sustain their weight loss only gain weight up to a certain limit.

“Bariatric surgery changes ‘set point,’ so even if there is weight regain, they virtually never exceed their pre-op weight,” he said. “What also needs to be kept in mind is that without surgery, the average patient that meets criteria continues to gain on average 5 to 6 pounds per year. They do not stay static.”

尽管成功地减轻了体重，但NIDDK解释说，许多减肥手术患者将经历潜在的终身 副作用， including osteoporosis, vitamin deficiencies, anemia, and difficulty digesting solid foods that can result in vomiting.

尽管有重大发现，但该研究的作者补充说，这项研究的整体设计是有缺陷的，原因有几个。

First, it was an observational study, rather than a randomized clinical trial.

“Ideally, randomized clinical trials would confirm — or refute — our findings,” explained Dr. David P. Fisher, the study’s first author 和最近退休的减肥外科医生。“但是这样的试验很昂贵且难以进行，并且可能无法与足够的患者一起评估这些相对罕见的结果。”

研究中的其他缺陷包括：

  • 在例行医生的约会期间收集了患者数据，这意味着缺少一些数据
  • 一些患者在完成之前离开了研究
  • 该研究的整体规模不足以适当地比较减肥手术和替代减肥方法

“For most people with diabetes and severe obesity, lifestyle changes and medication may not be successful at significantly lowering those risks,” said Dr. David Arterburn, MPH, a corresponding author, internist, and a senior investigator at Kaiser Permanente Washington Health Research Institute.

Arterburn说：“我们的结果增加了证据，这些证据应告知糖尿病患者与严重肥胖者之间的对话及其医疗保健提供者，涉及减肥手术的潜在益处和风险。”“我们希望这可以帮助他们做出有关他们的护理的更明智的决定。”

对于肥胖和患有2型糖尿病的人，在与医疗保健专业人员合作以改善其整体健康状况时，减肥手术应成为讨论的一部分。

In addition to weight loss, bariatric surgery greatly reduced the risk of neuropathy, heart disease, and death from heart attacks and strokes for participants in a recent study.

许多参与者在手术和减肥后的七年内还经历了糖尿病的缓解。

The most difficult part of getting bariatric surgery for many is insurance coverage.

The cost of the surgery is anywhere from $18,000 to $35,000 depending on the type of surgery chosen.