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Bariatric Surgery In Diabesity

Pharmacological Management Of Obesity In Compared with previous guidelines for bariatric
T2dm surgery, which used only BMI as sole parameter
to select surgical candidates, the DSS-II
Pharmacological management of hyperglycaemia in recommendations introduce the use of diabetes-
T2DM is of paramount importance yet consideration related parameters to help identify clinical paradigms
should be given to those medications that are weight where surgical treatment of T2D should be one of
neutral or have potential to augment weight loss, see the preferred options. DSS-II also elucidated the
Table below for classes of anti-diabetic drugs in these preoperative workup and postoperative follow-up of
categories and associated benefits and side effects [
patients undergoing metabolic surgery for T2D.
3]. The ideal anti-diabetic drug should produce Statements and recommendations of DSS –II – Salient
sustained weight loss with minimal side effects. points [5]
Such a drug is still elusive in the market today. Drugs
that target pathways in metabolic tissues, such as
adipocytes, liver and skeletal muscle, have shown Generalities
potential in preclinical studies but none has yet - Given its role in metabolic regulation, the GI tract
reached clinical development. constitutes a clinically and biologically meaningful
target for the management of T2D.
Numerous randomized clinical trials (RCTs) have
demonstrated that bariatric/metabolic surgery - There is now sufficient clinical and mechanistic
achieves superior glycemic control and reduction of evidence to support inclusion of GI surgery among
cardiovascular risk factors in obese patients with T2D antidiabetes interventions for people with T2D and
compared with various medical/lifestyle interventions. obesity.
Despite existing growing evidence diabetes treatment - Algorithms for treating T2D should include specific
algorithms do not include surgical options. scenarios in which metabolic surgery is considered
The 2nd Diabetes Surgery Summit (DSS-II), an to be a treatment option in addition to lifestyle,
international consensus conference, was convened nutritional, and/or pharmacological approaches.
in collaboration with leading diabetes organizations
to develop global guidelines to inform clinicians Metabolic Surgery Versus Traditional
and policymakers about benefits and limitations of Bariatric Surgery
metabolic surgery for T2D.
- Metabolic surgery—defined here as the use of GI
surgery with the intent to treat T2D and obesity—
Bariatric Surgery requires the development of a diabetes-based model
The most common bariatric surgery is gastric bypass of clinical practice consistent with international
(also called Roux-en-Y gastric bypass, RYGB): standards of diabetes care.
causing durable remission in majority of patients with - Complementary criteria to the sole use of BMI, need
T2D. Favored is Rou-en-Y, Biliopancreatic duodenal to be developed to achieve a better patient selection
diversion (duodenal switch) and to lesser extent algorithm for metabolic surgery.
vertical sleeve gastrectomy for better and sustained
weight reduction and metabolic control [4]. - RYGB, VSG, LAGB, and BPD classic or duodenal
switch variant (BPD-DS), are common metabolic
Gastric bypass patients lost an average of 25% of operations, each with its own risk-to-benefit ratio.
their body weight (and nearly 11% of their body fat),
gastric band dropped 15% of their weight (and 5.6% of - Metabolic surgery should be performed in high-
their body fat) and lifestyle group members lost 5.7% volume centers with multidisciplinary teams.
of their weight and 3% of their body fat.
Defining Goals And Success Of Metabolic
Bariatric operations can directly improve glycemic
control and not merely weight reduction. In 90% it Surgery
causes lowering blood sugar, reducing the dosage and - The aim of metabolic surgery in people with T2D
type of medication required and improving diabetes- and obesity is to improve their hyperglycemia and
related biochemical abnormalities, e.g. lipedema and other metabolic derangements, while reducing their
blood pressure control. It can induce remission in complications of diabetes, in order to improve their
78% of patients by bringing blood glucose to normal long-term health.
ranges and eliminating the need for medications.

GCDC 2017