Dixon John B
Baker IDI Heart and Diabetes Institute, Melbourne, Australia; School of Primary Health Care, Monash University, Melbourne, Australia.
Surg Obes Relat Dis. 2016 Jul;12(6):1171-7. doi: 10.1016/j.soard.2015.11.027. Epub 2015 Nov 27.
There is high-quality evidence that bariatric-metabolic surgery (BMS) generates positive health outcomes in patients with obesity and type 2 diabetes (T2D).
To understand the regional variations in the coverage and uptake of BMS, with a focus on T2D.
An Australian diabetes research institute.
A survey was conducted via a questionnaires sent to national leaders in BMS. The respondents provide their nations' BMS annual numbers, general and any T2D-specific indications for surgery, and source of surgical funding. The total population and adult diabetes prevalence (age 20-70 yr) of the countries were used to model the uptake of BMS for those with T2D.
Data were provided from 22 countries, representing approximately 75% of BMS procedures performed in 2014. BMS uptake varied from 885 per million total population per year in Belgium to 2 per million per year in Japan. The estimated proportion of eligible individuals with diabetes treated annually varied from 1.9% in The Netherlands to<.01% in China and Japan. Few countries treat>1% of estimated eligible patients annually. Of 22 countries, 19 have national guidelines for BMS, and all incorporate BMI in the selection criteria. Several countries have specific criteria for patients with T2D.
Results indicated that BMS has a negligible impact on the global burden of T2D. The low uptake indicates that BMS has not become an established treatment for T2D and emphasizes the need to define when it should be recommended as a standard of care. BMS needs to be integrated into the clinical pathways for managing T2D.
有高质量证据表明，减重代谢手术（BMS）可使肥胖和2型糖尿病（T2D）患者获得积极的健康结局。
了解BMS的覆盖范围和应用情况的地区差异，重点关注T2D。
一家澳大利亚糖尿病研究所。
通过向BMS领域的国家领导人发送问卷进行调查。受访者提供了本国BMS的年度手术例数、手术的一般指征及任何T2D特异性指征，以及手术资金来源。利用这些国家的总人口数和成人糖尿病患病率（20 - 70岁）来模拟T2D患者接受BMS的情况。
来自22个国家的数据，约占2014年BMS手术例数的75%。BMS的应用情况差异很大，从比利时每年每百万总人口885例到日本每年每百万2例。每年接受治疗的符合条件的糖尿病患者估计比例从荷兰的1.9%到中国和日本的<0.01%不等。很少有国家每年治疗的符合条件患者超过估计数的1%。在22个国家中，19个国家有BMS的国家指南，且所有指南在选择标准中都纳入了体重指数。几个国家对T2D患者有特定标准。
结果表明，BMS对全球T2D负担的影响可忽略不计。应用率低表明BMS尚未成为T2D的既定治疗方法，并强调需要明确何时应将其推荐为标准治疗。BMS需要纳入T2D的临床管理路径。
