The International Diabetes Federation Taskforce on Epidemiology and Prevention of Diabetes convened a consensus working group of diabetologists, endocrinologists, surgeons and public health experts to review the appropriate role of surgery and other gastrointestinal interventions in the treatment and prevention of Type 2 diabetes. The specific goals were: to develop practical recommendations for clinicians on patient selection; to identify barriers to surgical access and suggest interventions for health policy changes that ensure equitable access to surgery when indicated; and to identify priorities for research. Bariatric surgery can significantly improve glycaemic control in severely obese patients with Type 2 diabetes. It is an effective, safe and cost-effective therapy for obese Type 2 diabetes. Surgery can be considered an appropriate treatment for people with Type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially in the presence of other major co-morbidities. The procedures must be performed within accepted guidelines and require appropriate multidisciplinary assessment for the procedure, comprehensive patient education and ongoing care, as well as safe and standardized surgical procedures. National guidelines for bariatric surgery need to be developed for people with Type 2 diabetes and a BMI of 35 kg/m(2) or more.

https://www.soard.org/article/S1550-7289(11)00489-8/pdf

Bariatric surgery: an IDF statement for obese Type 2 diabetes

This study aims to assess the long-term effects of bariatric surgery on type 2 diabetic patients. We searched Cochrane Library, PubMed, and EMbase up to Dec 2013. Randomized controlled trials (RCTs) and cohort studies of bariatric surgery for diabetes patients that reported data with more than 2 years of follow-up were included. We used rigorous methods to screen studies for eligibility and collected data using standardized forms. Where applicable, we pooled data by meta-analyses. Twenty-six studies, including 2 RCTs and 24 cohort studies that enrolled 7883 patients, proved eligible. Despite the differences in the design, those studies consistently showed that bariatric surgery offered better treatment outcomes than non-surgical options. Pooling of cohort studies showed that BMI decreased by 13.4 kg/m2 (95 % confidence interval (CI), −17.7 to −9.1), fasting blood glucose by 59.7 mg/dl (95 % CI, −74.6 to −44.9), and glycated hemoglobin by 1.8 % (95 % CI, −2.4 to −1.3). Diabetes was improved or in remission in 89.2 % of patients, and 64.7 % of patients was in remission. Weight loss and diabetes remission were greatest in patients undergoing biliopancreatic diversion/duodenal switch, followed by gastric bypass, sleeve gastrectomy, and adjustable gastric banding. Bariatric surgery may achieve sustained weight loss, glucose control, and diabetes remission. Large randomized trials with long-term follow-up are warranted to demonstrate the effect on outcomes important to patients (e.g., cardiovascular events).

The Long-Term Effects of Bariatric Surgery for Type 2 Diabetes: Systematic Review and Meta-analysis of Randomized and Non-randomized Evidence

The International Diabetes Federation Taskforce on Epidemiology and Prevention of Diabetes convened a consensus working group of diabetologists, endocrinologists, surgeons and public health experts to review the appropriate role of surgery and other gastrointestinal interventions in the treatment and prevention of Type 2 diabetes. The specific goals were: to develop practical recommendations for clinicians on patient selection; to identify barriers to surgical access and suggest interventions for health policy changes that ensure equitable access to surgery when indicated; and to identify priorities for research. Bariatric surgery can significantly improve glycaemic control in severely obese patients with Type 2 diabetes. It is an effective, safe and cost-effective therapy for obese Type 2 diabetes. Surgery can be considered an appropriate treatment for people with Type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially in the presence of other major co-morbidities. The procedures must be performed within accepted guidelines and require appropriate multidisciplinary assessment for the procedure, comprehensive patient education and ongoing care, as well as safe and standardized surgical procedures. National guidelines for bariatric surgery need to be developed for people with Type 2 diabetes and a BMI of 35 kg/m² or more.

https://www.scielo.br/pdf/abem/v55n6/a03v55n6.pdf

Bariatric surgery: an IDF statement for obese Type 2 diabetes.

Obesity is globally prevalent and highly heritable, but its underlying genetic factors remain largely elusive. To identify genetic loci for obesity susceptibility, we examined associations between body mass index and similar to 2.8 million SNPs in up to 123,865 individuals with targeted follow up of 42 SNPs in up to 125,931 additional individuals. We confirmed 14 known obesity susceptibility loci and identified 18 new loci associated with body mass index (P < 5 x 10(-8)), one of which includes a copy number variant near GPRC5B. Some loci (at MC4R, POMC, SH2B1 and BDNF) map near key hypothalamic regulators of energy balance, and one of these loci is near GIPR, an incretin receptor. Furthermore, genes in other newly associated loci may provide new insights into human body weight regulation.

Association analyses of 249,796 individuals reveal 18 new loci associated with body mass index

Background
Remission of diabetes is seen in more than 60% of patients after bariatric surgery. There is extensive variability in the remission rates between different surgical procedures. We analyzed our database and aimed to develop an easy scoring system to predict the probability of diabetes remission after two surgical procedures i.e. Ileal Interposition coupled with Sleeve Gastrectomy (IISG) or Diverted Sleeve Gastrectomy (IIDSG).

/pdf/prediction-of-remission-after-metabolic-surgery-using-a-4n2snv6j6v.pdf

Prediction of remission after metabolic surgery using a novel scoring system in type 2 diabetes - a retrospective cohort study

Background: Bariatric surgery offers the best solution in management of obesity and related metabolic ailments, paving the way for a concept termed metabolic surgery. We report the results of a novel surgical procedure on glycemic control and metabolic syndrome in poorly controlled type 2 diabetes. Methods: Ten patients (four men, six women) underwent laparoscopic surgical procedure of sleeve gastrectomy and ileal interposition. All patients had diabetes for more than 3 years with poor control despite use of oral hypoglycemic agents (OHAs) and/or insulin. The primary outcome was remission of diabetes (hemoglobin A1c <7% without OHAs/insulin), and secondary outcomes were change in OHA requirement, components of metabolic syndrome, insulin resistance, and microalbuminuria. Results: We report the preliminary postoperative follow-up data of 9.1 ± 5.3 months (range, 2–16 months). Participants had a mean age of 48.2 ± 9 years (range, 34–62 years), duration of diabetes of 11 ± 5.7 years (range, 4–25 yea...

Ileal Interposition with Sleeve Gastrectomy for Control of Type 2 Diabetes

Aim: Combination of laparoscopic ileal interposition (II) with sleeve gastrectomy (SG) is an upcoming procedure, which offers good metabolic improvement and weight reduction without causing significant malabsorption. The objective of this study was to evaluate the results of this novel procedure for control of type 2 diabetes, obesity, hypertension, and related metabolic abnormalities. Materials and Methods: The II and SG was performed in 43 patients (M:F = 25:18) from February 2008. Participants had a mean age of 47.2 ± 8.2 years (range 29-66 years), mean duration of diabetes of 10.1 ± 9.2 years (range 1-32 years), and mean preoperative body mass index (BMI) of 33.2 ± 7.8 kg/m2. All patients had poorly controlled type 2 diabetes mellitus (DM) [mean glycated hemoglobin (HbA1C) 9.6 ± 2.1%] despite use of oral hypoglycemic agents (OHAs) and/or insulin. Thirty (70%) patients had hypertension, 20 (46%) had dyslipidemia, and 18 (42%) had significant microalbuminuria. The primary outcome was remission of diabetes (HbA1C < 6.5% without OHAs/insulin) and the secondary outcomes were reduction in antidiabetic agent requirement and components of metabolic syndrome. Results: Mean follow-up was for 20.2 ± 8.6 months (range 4-40 months). Postoperatively, glycemic parameters (fasting and post-lunch blood sugar, HbA1C improved in all patients (P < 0.05) at all intervals. Twenty (47%) patients had remission in diabetes and the remaining patients showed significantly decreased OHA requirement. All patients had weight loss between 15 and 30% (P < 0.05). Twenty-seven (90%) patients had remission in hypertension. At 3 years, the mean fall in HbA1C (34%) was more than reduction in BMI (25%). There was a declining trend in lipids and microalbuminuria postoperatively, though it was significant for microalbuminuria only. Conclusions: The laparoscopic II with SG seems to be a promising procedure for control of type 2 DM, hypertension, weight reduction, and associated metabolic abnormalities. A multicenter study with larger number of patients and a longer follow-up period is needed to substantiate our preliminary findings.

Ileal interposition with sleeve gastrectomy for treatment of type 2 diabetes mellitus

Article history: Received: 05 Feb 2011 Revised: 22 Apr 2011 Accepted: 07 May 2011

Vishwas Naik

Papers

Prediction of remission after metabolic surgery using a novel scoring system in type 2 diabetes - a retrospective cohort study

Ileal Interposition with Sleeve Gastrectomy for Control of Type 2 Diabetes

Ileal interposition with sleeve gastrectomy for treatment of type 2 diabetes mellitus

Remission of type 2 diabetes mellitus by ileal interposition with sleeve gastrectomy

Ileal switch with sleeve gastrectomy for control of type 2 diabetes