Dixon J B, Zimmet P, Alberti K G, Rubino F
Baker IDI Heart and Diabetes Institute, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
Arq Bras Endocrinol Metabol. 2011 Aug;55(6):367-82. doi: 10.1590/s0004-27302011000600003.
The International Diabetes Federation Taskforce on Epidemiology and Prevention of Diabetes convened a consensus working group of diabetologists, endocrinologists, surgeons and public health experts to review the appropriate role of surgery and other gastrointestinal interventions in the treatment and prevention of Type 2 diabetes. The specific goals were: to develop practical recommendations for clinicians on patient selection; to identify barriers to surgical access and suggest interventions for health policy changes that ensure equitable access to surgery when indicated; and to identify priorities for research. Bariatric surgery can significantly improve glycaemic control in severely obese patients with Type 2 diabetes. It is an effective, safe and cost-effective therapy for obese Type 2 diabetes. Surgery can be considered an appropriate treatment for people with Type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially in the presence of other major co-morbidities. The procedures must be performed within accepted guidelines and require appropriate multidisciplinary assessment for the procedure, comprehensive patient education and ongoing care, as well as safe and standardized surgical procedures. National guidelines for bariatric surgery need to be developed for people with Type 2 diabetes and a BMI of 35 kg/m² or more.
国际糖尿病联盟糖尿病流行病学与预防特别工作组召集了一个由糖尿病专家、内分泌学家、外科医生和公共卫生专家组成的共识工作组，以审查手术及其他胃肠道干预措施在2型糖尿病治疗和预防中的适当作用。具体目标如下：为临床医生制定关于患者选择的实用建议；确定手术准入的障碍，并就卫生政策变革提出干预措施，以确保在有指征时能公平获得手术治疗；确定研究重点。减重手术可显著改善重度肥胖2型糖尿病患者的血糖控制。对于肥胖的2型糖尿病患者，这是一种有效、安全且具有成本效益的治疗方法。对于那些采用药物治疗未达到推荐治疗目标的2型糖尿病和肥胖患者，尤其是存在其他主要合并症的患者，手术可被视为一种合适的治疗方法。手术必须在公认的指南范围内进行，并且需要对手术进行适当的多学科评估、对患者进行全面教育和持续护理，以及采用安全和标准化的手术程序。需要为BMI为35kg/m²及以上的2型糖尿病患者制定减重手术的国家指南。
