1 / 15

Dr. Monica Nannipieri Dipartimento di Medicina Clinica e Sperimentale Università di Pisa

Dr. Monica Nannipieri Dipartimento di Medicina Clinica e Sperimentale Università di Pisa. Cumulative Incidence of T2DM. Sjostrom L, J Int Med 2012. Cumulative Incidence and Remission of T2DM. Sjostrom L, J Int Med 2012. Surgical treatment effect on indicated end-point.

manasa
Download Presentation

Dr. Monica Nannipieri Dipartimento di Medicina Clinica e Sperimentale Università di Pisa

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Dr. Monica Nannipieri Dipartimento di Medicina Clinica e Sperimentale Università di Pisa

  2. Cumulative Incidence of T2DM Sjostrom L, J Int Med 2012

  3. Cumulative Incidence and Remission of T2DM Sjostrom L, J Int Med 2012

  4. Surgical treatment effect on indicatedend-point Sjostrom L, J Int Med 2012

  5. Cumulative Incidence of type 2 Diabetes over 15 years Sjoholm K, Diabetes Care 2013

  6. Metabolic Surgery for type 2 diabetes with BMI<35 kg/m2 Shimizu H, J Obes 2012

  7. Clinical outcomes of diabetes according to duration ofT2DM prior to surgery. Shimizu H, J Obes 2012

  8. Metabolic Surgery for type 2 diabetes with BMI<35 kg/m2Randomized trials ASMBS Clinical Issue Committee, Surg Obes Rel Dis 2013

  9. How Important Is Weight Loss in the Resolutionof Diabetes by Bariatric Surgery in Individualswith BMI <35 kg/m2? Lebovitz HE, Obes Surg 2013

  10. Recurrence of Diabetes After Metabolic SurgeryInduced Remission Lebovitz HE, Obes Surg 2013

  11. Conclusions International DiabetesFederation position statement 2011: “Surgeryshouldbeanacceptedoption in people whohave T2DM and BMI of 35 more. Surgeryshouldbeconsideredasan alternative treatment option in personswith BMI 30 to 35 whendiabetescannotbeadequatelycontrolledbyoptimalmedicalregimen, especially in the presenceofother major cardiovasculardiseaseriskfactors.” Evidencefrom the recentstudies: • A shorterhistoryofdiabeteswithlessnumberofinsulinusingpatients, a betterb-cellfunctionpriortometabolicsurgeryresulted in greaterremission rate ofdiabetes. • Furthermore, BMI alone isnotanadequatemeasuretodefine the overallriskofmorbidity and mortality in patientswith T2DM. • However, thereis no strong evidencedescribing the durabilityofmetabolicsurgery in long-term follow-up.

  12. Summary and recommendations • Forpatientswith BMI30–35 who do notachievesubstantial and durableweight and co-morbidityimprovementwith non surgicalmethods, bariatricsurgeryshouldbeanavailableoptionforsuitableindividuals. • The existing cut off of BMI,whichexcludesthosewithclass I obesity, wasestablishedarbitrarilynearly 20 years ago. • Thereis no currentjustification on groundsofevidenceofclinicaleffectiveness, cost-effectiveness, ethics, or equitythatthisgroupshouldbeexcludedfromlife-saving treatment. • Gastricbanding,sleeve gastrectomy,and gastric bypass havebeenshown in RCTstobewell-tolerated and effective treatment forpatientswith BMI30–35 in the short and medium term. ASMBS Clinical Issue Committee, Surg Obes Rel Dis 2013

  13. Remission of Type 2 Diabetes When? Predictors of successful sustained euglycemia Retnakaran R, Zinman B, Diabetes, Obesity and Metabolism, 2012.

  14. GLP-1 in remittens and no-remittens pg/ml pg/ml pg/ml pg/ml Minutes Minutes Nannipieri et al submitted Diab Care

  15. GLP-1 in remittens and no-remittens

More Related