In 2008, the overall prevalence of diabetes in people over 20 years of age was 9.7%, with a total of 92.4 million people, ranking first in the world. Obesity is an important risk factor for diabetes, and recent surveys have shown that the prevalence of diabetes among overweight and obese people in China is 12.8% and 18.5%, respectively.
Some surgical approaches in bariatric surgery are more effective than intensive drug therapy for obese patients with type 2 diabetes. Although conservative treatment and pharmacologic therapy remain the preferred treatment modality for type 2 diabetes, bariatric surgery may be an option for the treatment of type 2 diabetes in the setting of ineffective glycemic control. The premise of surgical treatment of type 2 diabetes is that the patient still has adequate islet function reserve.
Patients with obesity or overweight type 2 diabetes who need surgery need to meet the following criteria:
- Patients with type 2 diabetes who have had the disease for no more than 15 years and have some insulin secretion in the islets, with fasting serum C-peptide not less than 1/2 of the lower limit of normal;
- Age 16 to 65 years;
- Men with a waist circumference of not less than 90 cm and women with a waist circumference of not less than 85 cm are more suitable for surgical treatment;
- The patient’s body mass index is an important clinical criterion for determining suitability for surgery. First, surgery is actively recommended if the BMI is not less than 32.5; second, surgery may be considered if the weight is between 27.5 and 32.5; and caution is advised when the BMI is between 25.0 and 27.5.
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In addition, some patients with type 2 diabetes are also obese but not candidates for bariatric surgery, as seen primarily in the following conditions:
- A clear diagnosis of non-obese type 1 diabetes;
- Islet B-cell function is largely lost, with low serum C-peptide levels or a low C-peptide release curve under glucose load;
- Surgery is not currently recommended for those with a BMI less than 25.0;
- Patients with gestational diabetes and certain specific types of diabetes;
- Patients with gestational diabetes and certain specific types of diabetes
- Drug or alcohol abuse or uncontrollable mental illness;
- Patients with mental retardation or intellectual immaturity who are unable to control their own behavior;
- Those whose expectations of the procedure are not realistic;
- Those who are unwilling to assume the risk of potential complications from surgery;
- Those who cannot cooperate with postoperative diet and lifestyle changes and have poor compliance;
- People with poor general condition who have difficulty tolerating general anesthesia or surgery.
In conclusion, obese patients with type 2 diabetes should be scientifically guided by an experienced specialist to choose the right treatment for them. If weight loss surgery has been determined, active cooperation with the surgeon in preoperative preparation, regular postoperative follow-up, and nutritional and exercise instructions from the surgeon are also key to improving the effectiveness and safety of surgical treatment of type 2 diabetes.