Department of Surgery, Section of Metabolic Surgery, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA.
Ann Surg. 2010 Mar;251(3):399-405. doi: 10.1097/SLA.0b013e3181be34e7.
To develop guidelines for the use of gastrointestinal surgery to treat type 2 diabetes and to craft an agenda for further research.
Increasing evidence demonstrates that bariatric surgery can dramatically ameliorate type 2 diabetes. Not surprisingly, gastrointestinal operations are now being used throughout the world to treat diabetes in association with obesity, and increasingly, for diabetes alone. However, the role for surgery in diabetes treatment is not clearly defined and there are neither clear guidelines for these practices nor sufficient plans for clinical trials to evaluate the risks and benefits of such "diabetes surgery."
A multidisciplinary group of 50 voting delegates from around the world gathered in Rome, Italy for the first International Conference on Gastrointestinal Surgery to Treat Type 2 Diabetes--(the "Diabetes Surgery Summit"). During the meeting, available scientific evidence was examined and critiqued by the entire group to assess the strength of evidence and to draft consensus statements. Through an iterative process, draft statements were then serially discussed, debated, edited, reassessed, and finally presented for formal voting. After the Rome meeting, statements that achieved consensus were summarized and distributed to all voting delegates for further input and final approval. These statements were then formally critiqued by representatives of several sientific societies at the 1st World Congress on Interventional Therapies for T2DM (New York, Sept 2008). Input from this discussion was used to generate the current position statement.
A Diabetes Surgery Summit (DSS) Position Statement consists of recommendations for clinical and research issues, as well as general concepts and definitions in diabetes surgery. The DSS recognizes the legitimacy of surgical approaches to treat diabetes in carefully selected patients. For example, gastric bypass was deemed a reasonable treatment option for patients with poorly controlled diabetes and a body mass index > or =30 kg/m. Clinical trials to investigate the exact role of surgery in patients with less severe obesity and diabetes are considered a priority. Furthermore, investigations on the mechanisms of surgical control of diabetes are strongly encouraged, as they may help advance the understanding of diabetes pathophysiology.
The DSS consensus document embodies the foundations of "diabetes surgery," and represents a timely attempt by leading scholars to improve access to surgical options supported by sound evidence, while also preventing harm from inappropriate use of unproven procedures.
制定胃肠外科治疗 2 型糖尿病的临床应用指南，并制定进一步研究的议程。
越来越多的证据表明减重手术可以显著改善 2 型糖尿病。毫不奇怪，胃肠手术现在正在全球范围内用于治疗肥胖相关的糖尿病，而且越来越多地用于治疗单纯性糖尿病。然而，手术在糖尿病治疗中的作用尚未明确界定，既没有这些手术应用的明确指南，也没有足够的临床试验计划来评估此类“糖尿病手术”的风险和益处。
来自世界各地的 50 名具有投票权的多学科代表齐聚意大利罗马，参加第一届国际胃肠外科治疗 2 型糖尿病会议——（“糖尿病手术峰会”）。在会议期间，整个专家组对现有科学证据进行了审查和批评，以评估证据的强度，并起草共识声明。通过迭代过程，然后依次讨论、辩论、编辑、重新评估和最终提出正式投票的草案声明。罗马会议结束后，总结达成共识的声明并分发给所有投票代表，以进一步征求意见并最终批准。然后，由几个科学学会的代表在 2008 年 9 月（纽约）举行的第一届 2 型糖尿病介入治疗世界大会上对这些声明进行了正式批评。从这次讨论中获得的意见被用来生成当前的立场声明。
糖尿病手术峰会（DSS）立场声明包括对临床和研究问题的建议，以及糖尿病手术中的一般概念和定义。DSS 承认在精心挑选的患者中采用手术方法治疗糖尿病是合理的。例如，对于糖尿病控制不佳且体重指数≥30kg/m2的患者，胃旁路术被认为是一种合理的治疗选择。对于糖尿病合并肥胖程度较轻的患者，临床研究调查手术的确切作用被认为是当务之急。此外，强烈鼓励对手术控制糖尿病的机制进行研究，因为这有助于加深对糖尿病病理生理学的理解。
DSS 共识文件体现了“糖尿病手术”的基础，代表了领先学者的一项及时尝试，旨在改善对有充分证据支持的手术选择的获取，同时防止因使用未经证实的程序而造成伤害。
