Interpretation of the International Joint Statement on Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes.
- Author:
Peng ZHANG
1
;
Chengzhu ZHENG
2
Author Information
1. Center of Metabolic and Bariatric Surgery, Fudan University Pudong Hospital, Shanghai 201399, China.
2. Department of Minimally Invasive Surgery, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China. fredzhengzz@hotmail.com.
- Publication Type:Journal Article
- MeSH:
Aftercare;
standards;
Bariatric Surgery;
methods;
standards;
Biliopancreatic Diversion;
Blood Glucose;
physiology;
Body Mass Index;
Diabetes Mellitus, Type 2;
surgery;
Disease Management;
Gastrectomy;
Gastric Bypass;
Gastroplasty;
Humans;
Hyperglycemia;
surgery;
Laparoscopy;
Obesity;
surgery;
Patient Care Planning;
standards;
Practice Guidelines as Topic;
standards;
Remission Induction;
methods;
Treatment Outcome;
Weight Loss
- From:
Chinese Journal of Gastrointestinal Surgery
2017;20(4):372-377
- CountryChina
- Language:Chinese
-
Abstract:
Along with the soaring prevalence of obesity and type 2 diabetes mellitus (T2DM) globally, metabolic and bariatric surgery (MBS) has been rapidly developing into a major surgical subspecialty. However, the indications, benefits and potential risks of MBS are still controversial so far. In September 2015, the 2nd Diabetes Surgery Summit (DSS-II() was successfully convened, and later on an international joint statement on metabolic surgery in the treatment algorithm for T2DM was released based upon the consensus reached in DSS-II(, aiming to serve as a new global clinical guideline. The DSS-II( joint statement was initiated and endorsed by 5 leading international diabetes organizations, including American Diabetes Association (ADA), International Diabetes Federation (IDF), Chinese Diabetes Society (CDS), Diabetes India, as well as Diabetes UK, and was developed by an expert committee comprised of 48 international authorities as voting delegates. Up to the date of publication, the DSS-II( statement has been officially endorsed by 45 international professional associations/societies, including 30 non-surgical and 15 surgical organizations. In this statement, the following six aspects were recommended to differentiate MBS from traditional bariatric surgery: 1)The primary goal of MBS is to treat T2DM and to reduce the risk of T2DM complications; 2) In addition to a 50% or more of excess weight loss and normalization of glycemia, outcomes of diabetes complications should also be considered as clinical endpoints of MBS; 3) For patient selection, body mass index (BMI), T2DM treatment, as well as long-term risks versus benefits, including its effects on cardiovascular events (CVD), should all be considered; 4) T2DM and its complications, as well as pancreatic function reserve should be assessed pre-operatively; 5) Major surgical options include laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic adjustable gastric banding (LAGB), and bilio-pancreatic diversion with duodenal switch(BPD-DS). BPD-DS has the best outcome in T2DM remission followed by LRYGB, LSG and LAGB; 6) Glycemic variation should be intensively monitored, and if needed, managed following surgery. Clinical follow-up should be conducted at least once every six months within two years after surgery. For patients achieving complete remission from T2DM, diabetes complications should still be monitored within five years after surgery with the same frequency and protocols as pre-operatively.
