"METAbOlIC" SuRgER y fOR TREATMENT Of TyPE 2 DIAbETES MEllITuS

Objective:� Todiscussthepotentialcontributionof� "metabolic"�surgeryinprovidingoptimalmanagementof� patientswithtype�2�diabetesmellitus�(T2DM). � Methods:�Aliteraturesearchwasperformedwithuse� ofPubMed,�andtheclinicalexperienceoftheauthorswas� alsoconsidered. � Results:� Bariatric—or,� moreappropriately,� meta- bolic—surgicalprocedureshavebeenshowntoprovide� dramaticimprovementinbloodglucoselevels,� blood� pressure,�andlipidcontrolinobesepatientswithT2DM.� Inthesepatients,�metabolicsurgeryinvolvesalowriskof� short-termmortalityandasignificantlong-termsurvival� advantage,�whereasthediagnosisofdiabetesisassociated� withsignificantlong-termmortality.�Experimentalstudies� inanimalsandclinicaltrialssuggestthatgastrointestinal� bypassprocedurescancontroldiabetesandassociatedmet- abolicalterationsbymechanismsindependentofweight� loss.�Asaresult,�theuseofbariatricsurgeryandexperi- mentalgastrointestinalmanipulationstotreatT2DMis� increasing,�evenamonglessobesepatients.�Althoughbody� massindex�(BMI)�currentlyisthemostimportantfactor� foridentifyingcandidatesforbariatricsurgery,�evidence� showsthataspecificcutoffBMIvaluecannotaccurately� predictsuccessfulsurgicaloutcomes.�Furthermore,�BMI� appearslimitedindefiningtheriskprofileforpatientswith� T2DM. � Conclusion:� CurrentBMI-basedcriteriaforper- formanceofbariatricsurgeryarenotadequatefordeter- miningeligibilityforoperativetreatmentinpatientswith� diabetes.�Largeclinicaltrials,�comparingbariatricsurgery� versusoptimalmedicalcareofpatientswithT2DM,�should� begivenpriorityinordertodefinetheroleofsurgeryin� themanagementofdiabetes.�Recognizingtheneedtowork� asamultidisciplinaryteamthatincludesendocrinologists� andsurgeonsisaninitialstepinaddressingtheissues� andopportunitiesthatsurgeryofferstodiabetescareand� research.�(Endocr Pract. 2009;15:624-631)