In late March 2011, the International Diabetes Federation (IDF) issued a statement endorsing bariatric surgery as a treatment for type 2 diabetes and recommending that patients who are eligible for bariatric surgery consider it early to help prevent possible complications.
Bariatric surgery for the treatment of diabetes originally began as an unexpected clinical discovery. In the 1980s, gastric diversion surgery was originally used to treat obesity, but clinical observation unexpectedly revealed that those patients with obesity combined with diabetes improved significantly after surgery, and some could even stop taking glucose-lowering medications.
The following are the answers to the following questions:
Question 1 What are the types of bariatric surgery?
There are three main types of surgery: gastric bypass, adjustable gastric banding, and gastric sleeve resection. Gastric bypass surgery is also often referred to as gastric diversion, gastric bypass surgery, and gastrointestinal surgery. In the case of diabetic patients, gastric bypass surgery is mostly used.
Question 2 What are the results of bariatric surgery for type 2 diabetes?
It allows patients to control the disease without taking glucose-lowering medication after surgery. At the same time, researchers abroad have found that bariatric surgery has additional bariatric effects such as lowering systolic blood pressure, improving dyslipidemia, and reducing the risk of cardiovascular disease.
Question 3: What are the adverse effects of bariatric surgery?
The main immediate complications include intestinal obstruction, anastomotic fistula, pulmonary embolism, etc. The main long-term complications include gastroparesis, malnutrition, iron deficiency anemia, folic acid deficiency, vitamin B12 deficiency, and intractable diarrhea.
Bariatric surgery also carries a risk of mortality. A meta-analysis of the total mortality rate for bariatric surgery found that the 30-day postoperative mortality rate for laparoscopic gastric bypass was 0.5%. There have been several deaths in China.
Question 4: Who is a good candidate for bariatric surgery?
As mentioned above, there is still a lot of controversy about the indications for surgery in China. For this reason, we have adopted the contents of the “Expert Consensus on Surgical Treatment of Diabetes” jointly issued by the Chinese Medical Association Diabetes Branch and the Chinese Medical Association Surgery Branch. The details are as follows:
Indications for surgical treatment of diabetes mellitus:
1.Body mass index (BMI) ≥ 35 kg/m2 with or without comorbidities in a subset of people with type 2 diabetes.
2. Asian population with BMI between 30 and 35 kg/m2 and type 2 diabetes mellitus who have difficulty controlling blood glucose or comorbidities with lifestyle and medication, especially when they have cardiovascular risk factors.
3, BMI in the 28 to 29, 9 kg / m 2 Asian population, if combined with type 2 diabetes, and have centripetal obesity (waist circumference greater than 85 cm for women, more than 90 cm for men) and at least two additional metabolic syndrome criteria: high triglycerides, low HDL cholesterol levels, hypertension.
4, For adolescents with BMI ≥ 40 or BMI ≥ 35 kg/m2 with severe comorbidities, and age ≥ 15 years, skeletal maturity, and at level 4 or 5 according to Tanner developmental classification, adjustable gastric banding or gastrointestinal Roux-en-Y bypass may be considered with informed consent of the patient.
5. Patients with type 2 diabetes mellitus with a BMI of 25 to 27 and 9 kg/m2 should undergo surgery with the patient’s informed consent and in strict accordance with the study protocol. However, the nature of these procedures should be considered purely as part of an experimental study approved in advance by the ethics committee, and should not be widely promoted.
6. Patients with type 2 diabetes mellitus who are younger than 60 years of age or in good general health and at low risk for surgery.
Contraindications to surgery for diabetes mellitus:
1. Patients with drug or alcohol addiction or uncontrollable mental illness, and those who lack the ability to understand the risks, benefits, and expected consequences of metabolic surgery.
2. Patients with a clear diagnosis of type 1 diabetes mellitus.
3. Patients with type 2 diabetes whose pancreatic islet B-cell function has been largely lost.
4.Patients with combined bleeding disorders and cardiopulmonary function that cannot tolerate the surgery.
5.Diabetic patients with BMI less than 28kg/m2 and whose blood glucose can be satisfactorily controlled by medication and insulin.
6.Gestational diabetes and other special types of diabetes are temporarily excluded from the scope of surgical treatment.
Question 5: What is the remission rate of bariatric surgery?
A large-scale comprehensive analysis overseas found that 78.1% of patients could achieve complete remission of diabetes and 86.6% of patients had improved diabetes. In China, the remission rate varies depending on the indications for surgery and the perioperative management.
Q6 Is it necessary to control the diet after surgery?
Patients still need to control their diet after surgery. Of course, the postoperative diet control will not be as strict as the preoperative diet, but can be the same as normal people, we must be careful not to consume too much high-fat food, especially we must limit the consumption of alcohol, there are few patients who rebound due to excessive alcohol consumption after surgery.