Diabetes mellitus surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3] Karol Gema Hernandez, M.D. [4]
Overview
Type 2 diabetes can be cured by one type of gastric bypass surgery in 80-100% of severely obese patients. The effect is not due to weight loss because it usually occurs within days of surgery, which is before significant weight loss occurs. The pattern of secretion of gastrointestinal hormones is changed by the bypass and removal of the duodenum and proximal jejunum, which together form the upper (proximal) part of the small intestine.[1] One hypothesis is that the proximal small intestine is dysfunctional in type 2 diabetes; its removal eliminates the source of an unknown hormone that contributes to insulin resistance.[2] This surgery has been widely performed on morbidly obese patients and has the benefit of reducing the death rate from all causes by up to 40%.[3] A small number of normal to moderately obese patients with type 2 diabetes have successfully undergone similar operations.[4][5]
2014
Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association 2014 recommendations of Beta cell replacement therapy
- Consider solid organ pancreas transplantation simultaneously with kidney transplantation in patients with type 1 diabetes who have an indication for kidney transplantation and are poorly controlled with large glycemic excursions. (B)
- Consider solid organ pancreas transplantation after kidney transplantation in adult patients with type 1 diabetes who have already received a kidney transplant. (C)
- Judiciously consider solid organ pancreas transplantation alone in adults with type 1 diabetes, unstable glucose control, hypoglycemia unawareness, and an increased risk of diabetes-related mortality, who have attempted all of the more traditional approaches to glycemic control and have remained unsuccessful, yet are judged responsible enough to manage the antirejection medication regimen, risks, and follow-up required with an organ transplant. (C)
- Consider referral to research centers for protocolized islet cell transplantation in patients with type 1 diabetes and debilitating complications of diabetes who are interested in research possibilities and fit the criteria for the research protocol. (E)
2013 American Diabetes Association Standards of Medical Care in Diabetes (DO NOT EDIT)[6]
Bariatric Surgery
| "1. Bariatric surgery may be considered for adults with BMI 35 kg/m2 and type 2 diabetes, especially if the diabetes or associated comorbidities are difficult to control with lifestyle and pharmacological therapy. (Level of Evidence: B)" |
| "2. Patients with type 2 diabetes who have undergone bariatric surgery need life- long lifestyle support and medical monitoring. (Level of Evidence: B)" |
| "3. Although small trials have shown gly-cemic benefit of bariatric surgery in patients with type 2 diabetes and BMI 30–35 kg/m2, there is currently insufficient evidence to generally recommend surgery in patients with BMI <35 kg/m2 outside of a research protocol. (Level of Evidence: E)" |
| "4. The long-term benefits, cost-effectiveness, and risks of bariatric surgery in individuals with type 2 diabetes should be studied in well-designed controlled trials with optimal medical and lifestyle therapy as the comparator. (Level of Evidence: E)" |
References
- ↑ Rubino, F (2002). "Potential of surgery for curing type 2 diabetes mellitus". Ann. Surg. 236 (5): 554–9. ISSN 0003-4932. PMID 12409659. Unknown parameter
|coauthors=ignored (help) - ↑ Rubino, F (2006). "The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes". Ann. Surg. 244 (5): 741–9. PMID 17060767. Unknown parameter
|coauthors=ignored (help) - ↑ Adams, TD (2007). "Long-term mortality after gastric bypass surgery". N. Engl. J. Med. 357 (8): 753–61. doi:10.1056/NEJMoa066603. ISSN 0028-4793. PMID 17715409. Unknown parameter
|coauthors=ignored (help) - ↑ Cohen, RV (2007). "Duodenal-jejunal bypass for the treatment of type 2 diabetes in patients with body mass index of 22-34 kg/m2: a report of 2 cases". Surg Obes Relat Dis. 3 (2): 195–7. doi:10.1016/j.soard.2007.01.009. PMID 17386401. Unknown parameter
|coauthors=ignored (help) - ↑ Vasonconcelos, Alberto (2007-09-01). "Could type 2 diabetes be reversed using surgery?". New Scientist (2619): 11–13. Retrieved 2007-09-26. Check date values in:
|date=(help) - ↑ American Diabetes Association (2013). "Standards of medical care in diabetes--2013". Diabetes Care. 36 Suppl 1: S11–66. doi:10.2337/dc13-S011. PMC 3537269. PMID 23264422.