Diapositiva 1

1
Dr. Monica Nannipieri Dipartimento di Medicina
Clinica e Sperimentale Università di Pisa
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Cumulative Incidence of T2DM
Sjostrom L, J Int Med 2012
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Cumulative Incidence and Remission of T2DM
Sjostrom L, J Int Med 2012
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Surgical treatment effect on indicated end-point
Sjostrom L, J Int Med 2012
5
Cumulative Incidence of type 2 Diabetes over 15
years
Sjoholm K, Diabetes Care 2013
6
Metabolic Surgery for type 2 diabetes with
BMIlt35 kg/m2
Shimizu H, J Obes 2012
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Clinical outcomes of diabetes according to
duration ofT2DM prior to surgery.
Shimizu H, J Obes 2012
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Metabolic Surgery for type 2 diabetes with
BMIlt35 kg/m2Randomized trials
ASMBS Clinical Issue Committee, Surg Obes Rel Dis
2013
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How Important Is Weight Loss in the Resolutionof
Diabetes by Bariatric Surgery in Individualswith
BMI lt35 kg/m2?
Lebovitz HE, Obes Surg 2013
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Recurrence of Diabetes After Metabolic
SurgeryInduced Remission
Lebovitz HE, Obes Surg 2013
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Conclusions

• International Diabetes Federation position
  statement 2011
• Surgery should be an accepted option in people
  who have T2DM and BMI of 35 more. Surgery should
  be considered as an alternative treatment option
  in persons with BMI 30 to 35 when diabetes cannot
  be adequately controlled by optimal medical
  regimen, especially in the presence of other
  major cardiovascular disease risk factors.
• Evidence from the recent studies
• A shorter history of diabetes with less number of
  insulin using patients, a better b-cell function
  prior to metabolic surgery resulted in greater
  remission rate of diabetes.
• Furthermore, BMI alone is not an adequate measure
  to define the overall risk of morbidity and
  mortality in patients with T2DM.
• However, there is no strong evidence describing
  the durability of metabolic surgery in long-term
  follow-up.

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Summary and recommendations

• For patients with BMI3035 who do not achieve
  substantial and durable weight and co-morbidity
  improvement with non surgical methods, bariatric
  surgery should be an available option for
  suitable individuals.
• The existing cut off of BMI,which excludes those
  with class I obesity, was established arbitrarily
  nearly 20 years ago.
• There is no current justification on grounds of
  evidence of clinical effectiveness,
  cost-effectiveness, ethics, or equity that this
  group should be excluded from life-saving
  treatment.
• Gastric banding,sleeve gastrectomy,and gastric
  bypass have been shown in RCTs to be
  well-tolerated and effective treatment for
  patients with BMI3035 in the short and medium
  term.

ASMBS Clinical Issue Committee, Surg Obes Rel Dis
2013
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Remission of Type 2 Diabetes When?
Predictors of successful sustained euglycemia
Retnakaran R, Zinman B, Diabetes, Obesity and
Metabolism, 2012.
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GLP-1 in remittens and no-remittens
Nannipieri et al submitted Diab Care
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GLP-1 in remittens and no-remittens