Sapunar Jorge, Escalona Alex, Araya A Verónica, Aylwin Carmen Gloria, Bastías María Juliana, Boza Camilo, Cárcamo Carlos, Csendes A Attila, Davidof F Patricio, Funke Ricardo, Gómez Patricia, González María Isabel, Lahsen Rodolfo, Lanzarini Enrique, Maíz Alberto, Mujica Verónica, Muñoz Rodrigo, Pérez Gustavo, Raimann Félix, Salman Patricio, Sepúlveda Matías, Soto Néstor, Villagrán Rodrigo
Departamento de Medicina Interna y Centro EPICYN, Facultad de Medicina, Universidad de la Frontera, Temuco, Chile.
Clínica Universidad de los Andes, Facultad de Medicina, Universidad de los Andes, Santiago, Chile.
Rev Med Chil. 2018 Dec;146(10):1175-1183. doi: 10.4067/S0034-98872018001001175.
Diabetes Mellitus (DM) and obesity are a public health problem in Chile. Bariatric surgery is the most effective treatment alternative to achieve a significant and sustained weight reduction in patients with morbid obesity. The results of controlled clinical trials indicate that, compared to medical treatment, surgery for obese patients with DM2 allows a better control of blood glucose and cardiovascular risk factors, reduces the need for medications and increases the likelihood for remission. Consensus conferences and clinical practice guidelines support bariatric surgery as an option to treat DM2 in Class III Obesity (Body Mass Index (BMI) > 40) regardless of the glycemic control and the complexity of pharmacological treatment and in Class II Obesity (BMI 35-39,9) with inadequate glycemic control despite optimal pharmacological treatment and lifestyle. However, surgical indication for patients with DM2 and BMI between 30-34.9, the most prevalent sub-group, is only suggested. The Chilean Societies of Endocrinology and Diabetes and of Bariatric and Metabolic Surgery decided to generate a consensus regarding the importance of other factors related to DM2 that would allow a better selection of candidates for surgery, particularly when weight does not constitute an indication. Considering the national reality, we also need a statement regarding the selection and characteristics of the surgical procedure as well as the role of the diabetologist in the multidisciplinary team.
糖尿病（DM）和肥胖是智利的一个公共卫生问题。减肥手术是病态肥胖患者实现显著且持续减重的最有效治疗选择。对照临床试验结果表明，与药物治疗相比，为2型糖尿病肥胖患者实施手术能更好地控制血糖和心血管危险因素，减少药物需求，并增加病情缓解的可能性。共识会议和临床实践指南支持减肥手术作为治疗Ⅲ级肥胖（体重指数（BMI）>40）的2型糖尿病患者的一种选择，无论其血糖控制情况以及药物治疗的复杂性如何；对于Ⅱ级肥胖（BMI 35 - 39.9）且尽管接受了最佳药物治疗和生活方式干预但血糖控制仍不佳的患者，减肥手术也是一种选择。然而，对于2型糖尿病且BMI在30 - 34.9之间的患者（这是最常见的亚组），手术指征仅为推荐。智利内分泌与糖尿病学会以及减肥与代谢外科学会决定就与2型糖尿病相关的其他因素的重要性达成共识，以便更好地筛选手术候选人，特别是在体重不构成手术指征的情况下。考虑到国内实际情况，我们还需要一份关于手术方式的选择和特点以及糖尿病专家在多学科团队中的作用的声明。
