1. Bariatric Surgery Metabolic Aspects, Indications & Pre-Operative Preparation Abeezar I. Sarela St James’s University Hospital &The Nuffield Hospital Leeds, UK
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4. Resolution of T2DM is “Dose-Related” Buchwald et al. JAMA 2004;292:1724-1737 98% 84% 48% Resolution of T2DM 1.1% 0.5% 0.1% Operative mortality 70% 62% 47% Excess weight loss Duodenal Switch Bypass Band
22. Appropriate BMI for Asian populations and its implications for policy and intervention strategies. WHO expert consultation. Lancet 2004;363:157-163. Indian Population Overweight: BMI>23 kg/m 2 Obese: BMI>25 kg/m 2 Morbid obesity (+co-morbidity): BMI>32.5 kg/m 2 Abnormal Waist Circumference Men >90 cm Women >80 cm
23. Unified Criteria for Clinical Diagnosis of the Metabolic Syndrome Lancet 2010;375:181-183 > 100 mg/dl Increased fasting blood glucose (or medication) Systolic ≥130 or Diastolic ≥ 85 mmHg Increased blood pressure (or medication) <40 mg/dl in men <50 mg/dl in women Reduced HDL cholesterol (or medication) ≥ 150 mg/dl Increased triglycerides (or medication) Population-specific definition Increased waist circumference
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27. Incidence of Adverse Events by OS-MRS Class A: 4% 229 patients Class B: 6% 137 patients Class C: 23% 15 patients One death 7% of OS-MRS C 0.3% of total AI Sarela, SP Dexter, MJ McMahon. 381 operations in 2009. SOARD, 2010
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30. Kahn et al Nature 2006;444:840 Link between Obesity & Type 2 Diabetes
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Notas del editor
Precise BMI cut-off at 35 is not an accurate parameter to predict the potential of surgery to induce glycaemic and metabolic control. No existing studies have shown evidence of excessive weight loss following conventional bariatric operations in patients with BMI 30-35.
Weight loss alone explains diabetes control after LAGB (A) Intestinal bypass procedures (RYGB, BPD, D-J bypass) appear to engage additional anti-diabetic mechanisms beyond those restricted to food intake and weight.(A)
Why has gastric bypass not become the accepted treatment for diabetes for obese patients? The concept of GI surgery as an endocrine modifier has been fully embraced by the clinical community. Perception that bariatric surgery offers nothing more than the motivation to change unhealthy lifestyle habits - precept that surgery treats diseases through mechanical changes rather than changes in the underlying pathophysiological mechanisms. Willingness to wait and hope for a new drug!
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