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[在减肥/代谢手术过程中使用抗糖尿病药物]
1Professeur honoraire, Service de diabétologie, nutrition et maladies métaboliques, Département de médecine, Centre hospitalier universitaire de Liège, 4000 Liège, Belgique.
Revue medicale suisse
|August 23, 2023
概括
经过胃绕道术或袖子胃切除术后管理2型糖尿病 (T2D) 需要仔细调整药物. 在手术前,停止使用gliflozins;减少/停止使用硫尿素和胰岛素,以预防低血糖和酸性胰岛素.
科学领域:
- 内分泌学 在内分泌学.
- 腹部外科 腹部外科
- 代谢障碍 代谢障碍 代谢障碍
背景情况:
- 2型糖尿病 (T2D) 管理需要量身定制的方法,特别是在减肥手术后.
- 胃绕道和袖子胃切除术显著改变葡萄糖代谢.
- 具体的药物调整对于优化结果和最大限度地降低风险至关重要.
研究的目的:
- 概述了在接受或经过胃绕道或袖子胃切除术的患者中管理T2D的关键考虑因素.
- 为减肥手术前后对药物调整提供指导.
- 针对T2D缓解和持续高血糖的管理策略.
主要方法:
- 审查当前的文献和临床指南T2D管理后腹腔外科手术.
- 分析与特定药物类别相关的药物风险 (低血糖症,euglycemic糖尿病酸性酸症).
- 讨论维持T2D缓解和管理高血糖复发的策略.
主要成果:
- 预干预:必须停止使用gliflozin,以预防euglycemic糖尿病酸性酸性疾病. 应停止使用硫类尿素,并谨慎降低胰岛素剂量,以避免低血糖.
- 缓解:考虑维持甲福明或GLP-1受体激动剂以延长缓解.
- 持续性/复发性:高血糖管理应与非手术患者的标准T2D治疗方案保持一致.
结论:
- 仔细的,个性化的药物管理对于接受减肥手术的T2D患者至关重要.
- 手术前的积极调整和手术后的战略选择是患者安全和T2D控制的关键.
- 长期监测和治疗调整是持续缓解或高血糖管理的必要条件.
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