Treating diabetes with surgery

摘要

THAT TYPE 2 DIABETES REMISSION MAY BE INDUCED BY BAR-iatric surgery in patients with grade 2 (body mass index [BMI] >35) and grade 3 (BMI >40) obesity soon after operation and preceding weight loss has stimulated new ideas regarding diabetes treatment. Some investigators have proposed surgical intervention for patients with type 2 diabetes with grade 1 obesity (BMI >=30), with some even proposing bariatric surgery as the primary treatment for patients with type 2 diabetes and BMI as low as 27. The term metabolic surgery is commonly used to describe this class of surgical procedures because they primarily modify a patient's physiology for the better as opposed to simply correcting or removing an anatomic defect. Extending surgical treatment to these categories of patients has substantial implications for the health care system. In 2012, data from the National Health and Nutrition Examination Survey (NHANES)3 indicated that 69.2% of the US population had a BMI of 25 or higher, 35.9% had a BMI of 30 or higher, 155% had a BMI of 35 or higher; and 6.3% had a BMI of 40 or higher. Approximately 20% of the US adult population has a BMI ranging from 30 to 35, and the prevalence of type diabetes in this population is approximately 20%. Thus, approximately 4% of the US population has a BMI ranging from 30 to 35 and diabetes. Any proposal to treat this large number of patients surgically must be carefully evaluated.