Core tips: surgical treatment of diabetes?
As we all know, diabetes generally coexists with obesity. Most patients with type 2 diabetes have different degrees of obesity. It is precise because obesity is a high-risk factor for diabetes, so weight control plays an increasingly important role in the treatment of diabetes. It has become a new idea to treat diabetes through bariatric surgery and has received good results.
What is bariatric surgery?
Weight loss surgery was originally designed for patients with severe obesity, the effect of weight loss is very good. According to different operations, weight loss surgery can be roughly divided into three categories: ① restrictive surgery, represented by adjustable gastric banding (AGB); ② malabsorption surgery, represented by biliopancreatic diversion (BPD); ③ combined surgery, mainly Roux-en-Y gastric bypass (Roux-en-Y gastric bypass) Bypass, RYGB).
In the long-term observation of the effect of bariatric surgery, we found that bariatric surgery can change the coexisting glucose metabolism disorder, which brings good news for obese patients with diabetes
Weight loss surgery for diabetes is recognized
In 2011, the American Association for the treatment of type 2 diabetes officially recognized obesity as one of the treatment measures for type 2 diabetes In, the diabetes branch of the Chinese Medical Association and the surgery branch of the Chinese Medical Association also recognized bariatric surgery as one of the means to treat obese type 2 diabetes. It can be seen that weight loss surgery for diabetes has been recognized by medical circles at home and abroad.
Can bariatric surgery cure diabetes?
No matter how high or low blood sugar is treated by western medicine, it can not be cured. However, the effect of bariatric surgery in the treatment of diabetes is very optimistic: Foreign Studies in 2009 showed that 70% of the patients with diabetes have been completely alleviated, and studies on Chinese patients with type 2 diabetes in 2010 found that bariatric surgery in the treatment of Chinese patients with type 2 diabetes can also achieve satisfactory results. Although the result is optimistic, it is still impossible to equate with the cure. Because the disease has only been alleviated and did not reach the standard of cure. At the same time, bariatric surgery also has certain risks, such as intestinal obstruction, anastomotic leakage, pulmonary embolism, etc. Although the incidence is not high, it is still inevitable.
Mechanism of bariatric surgery for diabetes
First of all, bariatric surgery can be weight loss, that is to say, weight loss is initially considered to be the most important cause of diabetes remission after bariatric surgery. However, other studies have shown that blood glucose and serum insulin levels can return to normal within a few days after weight loss surgery, which is far earlier than the time of weight loss. In other words, this view holds that the remission of diabetes is not secondary to the weight loss effect of severe obesity, but a primary specific effect. There are not all patients are suitable for weight loss surgery. The Chinese guidelines for surgical treatment of obesity and type 2 diabetes point out the suitable population for bariatric surgery
The duration of type 2 diabetes is less than or equal to 15 years, the islets have certain insulin secretion function, fasting C-peptide ≥ half of the lower limit of normal value; age 16-65 years; BMI ≥ 32.5; BMI between 27.5 and 32.5 has strict indications; male waist circumference ≥ 90cm, female waist circumference ≥ 85CM.
In conclusion, although more and more studies have shown that bariatric surgery can achieve better metabolic control than traditional medical treatment, its long-term efficacy in improving or alleviating diabetes still needs to be confirmed in large-scale clinical trials.
