Obezitesi ve Tip 2 Diyabeti Olan Hastada Metabolik Cerrahi Düşünüyorum

ÖzObezite ve obezitenin tetiklediği hastalıklar önünü alamadığımız bir salgın olarak modern toplumu tehdit etmektedir. Bariatrik cerrahi yöntemler obezite tedavisinde uzun süredir etkin bir tedavi yöntemi olarak kullanılmaktadır. Tip 2 diyabet, hipertansiyon, yağlı karaciğer, dislipidemi gibi yandaş hastalıkların tedavisi, obez bireylerde planlanan cerrahi tedavilerin hedefini genişletmiş ve tedavinin metabolik olumlu sonuçları en az kilo vermek kadar önem kazanmıştır. Cerrahi sonrası henüz belirgin kilo vermeye yeni başlamışken bile glisemik kontrolün etkin bir şekilde sağlanabildiği anlaşılmış ve gastrointestinal sistem manüpülasyonları ile diyabet tedavisinde başarı sağlanabileceği hem deneysel hem deklinik çalışmalarda gösterilmiştir. Yapılan randomize karşılaştırmalı çalışmalarda diyabet kontrolü için metabolik cerrahi tedavi en iyi medikal tedaviye üstünbulunmuştur. Ayrıca metabolik cerrahi yöntemler ile elde edilen sonuçlar diyabet kontrolü ile sınırlı kalmamış ve trigliserid ve HDL düzeylerinde iyileşme, sis-tolik ve diastolik kan basıncında azalma ile beraber kardiyovasküler risk azalma-sı sağlanabilmiştir. Tip 2 diyabet tedavisinde, cerrahi yöntemlerin giderek geniş-leyen endikasyon kriterleri ile tedavi algoritmalarının önemli bir parçası olmasıkaçınılmaz gözükmektedir.

Anahtar Kelimeler:

Metabolik cerrahi, Tip 2 diyabet, Obezite, Bariatrikcerrahi

I am Considering Metabolic Surgery For Patient whois Obese and has Type 2 Diabetes

AbstractObesity and obesity related diseases endanger modern society as an unpreventable pandemic. Bariatric surgery has been performed with great success in the treatment of morbid obesity for many years. Treatment of obesity related diseases suchas type 2 diabetes, hypertension, fatty liver and dyslipidemia have expanded the targets of treatment and metabolic results have become as important as loosing excess weight. It has been observed that effective glycemic control could be achieved before substantial weight loss and both experimental and clinical studies suggested thatgastrointestinal tract manipulation could be used for the treatment of diabetes. In randomized trials metabolic surgical treatment has been shown to be superior to intense medical treatment for glysemic control in diabetic patients. Additionally it has been documented that metabolic surgery not only achieved glycemic control butalso result in decrease in cardiovascular risk with improvement in triglyseride and HDL-cholesterol levels as well as decrase in systolic and diastolic blood pressure.It is clear that metabolic surgery has and will have an important part in the treatmentalgorithyms of type 2 diabetes with expanding indications.

Keywords:

Metabolic surgery, Type 2diabetes, Obesity, Bariatricsurgery,

PDF

___

Kaynaklar 1.Komlos, John and Brabec, Marek, The Trend of BMI Va-lues Among US Adults (March 2010). CESifo Working Pa-per Series No. 2987. Available at SSRN: https://ssrn.com/abstract=1573500 2.World Health Organization; 2017, Global health obser-vatory (http://www.who.int/gho/en/) 3.Printz C. Extreme obesity may shorten life expectancy upto 14 years. Cancer. 2014;120: 3591. 4.Angrisani L, Santonicola A, Iovino P, Formisano G, Buch-wald H, Scopinaro N. Bariatric Surgery Worldwide2013. Obes Surg. 2015; 25:1822-32. 5.Fried M, Yumuk V, Oppert JM, Scopinaro N, Torres A,Weiner R, et al; International Federation for Surgery ofObesity and Metabolic Disorders-European Chapter(IFSO-EC); European Association for the Study of Obe-sity (EASO); European Association for the Study of Obe-sity Obesity Management Task Force (EASO OMTF). In-terdisciplinary European guidelines on metabolic and ba-riatric surgery. Obes Surg. 2014 ;24:42-55. 6.Cohen RV, Shikora S, Petry T, Caravatto PP, Le Roux CW.The Diabetes Surgery Summit II Guidelines: a Disease-Based Clinical Recommendation. Obes Surg. 2016;26:1989-91. 7.Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KG,Zimmet PZ, et al.; Delegates of the 2nd Diabetes SurgerySummit. Metabolic Surgery in the Treatment Algorithm for ype 2 Diabetes: A Joint Statement by International Dia-betes Organizations. Diabetes Care. 2016; 39:861-77. 8.Rubino F, Marescaux J. Effect of duodenaljejunal exclu-sion in a non-obese animal model of type 2 diabetes: anew perspective for an old disease. Ann Surg.2004;239:1–11. 9.Breen DM, Rasmussen BA, Kokorovic A, Wang R, Che-ung GW, Lam TK. Jejunal nutrient sensing is required forduodenal-jejunal bypass surgery to rapidly lower gluco-se concentrations in uncontrolled diabetes. Nat Med.2012;18:950–5. 10.Thaler JP, Cummings DE. Minireview: hormonal and me-tabolic mechanisms of diabetes remission after gastroin-testinal surgery. Endocrinology. 2009;150:2518–25. 11.Madsbad S, Dirksen C, Holst JJ. Mechanisms of chan-ges in glu- cose metabolism and bodyweight after bari-atric surgery. Lancet Diabetes Endocrinol. 2014;2:152–64. 12.Schauer PR, Bhatt DL, Kirwan JP, Wolski K, BrethauerSA, Navaneethan SD, et al. Bariatric surgery versus in-tensive medical therapy for diabetes—3-year outcomes.N Engl J Med. 2014;370:2002–13. 13.Ikramuddin S, Korner J, Lee W-J, Connett JE, Inabnet WB,Billington CJ, et al. Roux-en-Y gastric bypass vs inten-sive medical management for the control of type 2 dia-betes, hypertension, and hyperlipidemia: the Diabetes Sur-gery Study Randomized Clinical Trial Roux-en-Y GastricBypass and Diabetes. JAMA. 2013;309:2240–9. 14.Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A,Brethauer SA, et al.; STAMPEDE Investigators. Bariat-ric Surgery versus Intensive Medical Therapy for Diabe-tes - 5-Year Outcomes. N Engl J Med. 2017; 376:641-651. 15.Mingrone G, Panunzi S, De Gaetano A, Guidone C, Ia-conelli A, Leccesi L, et al. Bariatric- metabolic surgeryversus conventional medical treatment in obese patientswith type 2 diabetes: 5 year follow-up of an open-label,single-centre, randomised controlled trial. Lancet.2015;386(9997):964–73. 16.Cohen RV, Pinheiro JC, Schiavon CA, Salles JE, Wajc-henberg BL, Cummings DE. Effects of gastric bypass sur-gery in patients with type 2 diabetes and only mild obe-sity. Diabetes Care. 2012 17.Cummings DE, Cohen RV. Beyond BMI: the need for newguide- lines governing the use of bariatric and metabo-lic surgery. Lancet Diabetes Endocrinol. 2014;2:175–81. 18.Reis CE, Alvarez-Leite JI, Bressan J, Alfenas RC. Roleof bariatric-metabolic surgery in the treatment of obesetype 2 diabetes with body mass index <35 kg/m2: a lite-rature review. Diabetes Technol Ther. 2012; 14:365–72. 19.Brethauer SA, Aminian A, Romero-Talamás H, BatayyahE, Mackey J, Kennedy L, et al. Can diabetes be surgicallycured? Long-term metabolic effects of bariatric surgeryin obese patients with type 2 diabetes mellitus. Ann Surg.2013; 258:628-36. 20.Aminian A, Brethauer SA, Andalib A, Punchai S, MackeyJ, Rodriguez J, et al. Can Sleeve Gastrectomy "Cure" Dia-betes? Long-term Metabolic Effects of Sleeve Gastrectomyin Patients With Type 2 Diabetes. Ann Surg. 2016;264:674-81. 21.Parikh M, Chung M, Sheth S, McMacken M, Zahra T, Sa-unders JK, et al. Randomized pilot trial of bariatric sur-gery versus intensive medical weight management on dia-betes remission in type 2 diabetic patients who do NOT meetNIH criteria for surgery and the role of soluble RAGE asa novel biomarker of success. Ann Surg. 2014; 260: 617–22. 22.Keating C, Neovius M, Sjöholm K, Peltonen M, Narbro K,Eriksson JK, et al. Health-care costs over 15 years after ba-riatric surgery for patients with different baseline glucosestatus: results from the Swedish Obese Subjects study. Lan-cet Diabetes Endocrinol. 2015; 3:855-65. 23.Courcoulas AP, Belle SH, Neiberg RH, Pierson SK, Eag-leton JK, Kalarchian MA, et al. Three-year outcomes ofbariatric surgery vs lifestyle intervention for type 2 dia-betes mellitus treatment: a randomized clinical trial. JAMASurg. 2015;150:931–40 24.Ikramuddin S, Billington CJ, Lee WJ, Bantle JP, ThomasAJ, Connett JE et al. Roux-en-Y gastric bypass for dia-betes (the Diabetes Surgery Study): 2-year outcomes ofa 5-year, randomised, controlled trial. Lancet DiabetesEndocrinol. 2015;3:413–22. 25.Halperin F, Ding SA, Simonson DC, Panosian J, Goebel-Fabbri A, Wewalka M et al. Roux-en-Y gastric bypass sur-gery or lifestyle with intensive medical management in pa-tients with type 2 diabetes: feasibility and 1-year resultsof a randomized clinical trial. JAMA Surg.2014;149:716–26. 26.Ding SA, Simonson DC, Wewalka M, Halperin F, Fos-ter K, Goebel-Fabbri A, et al. Adjustable gastric band sur-gery or medical management in patients with type 2 dia-betes: a randomized clinical trial. J Clin Endocrinol Me-tab. 2015;100:2546–56. 27.Mingrone G, Panunzi S, De Gaetano A, Guidone C, Ia-conelli A, Leccesi L, et al. Bariatric surgery versus con-ventional medical therapy for type 2 diabetes. N Engl JMed. 2012;366:1577–85. 28.Kota SK, Ugale S, Gupta N, Modi KD. Laparoscopic ile-al interposition withdiverted sleeve gastrectomy for tre-atment of type 2 diabetes. Diabetes MetabSyndr. 2012;6:125-31. 29.Santoro S, Castro LC, Velhote MC, Malzoni CE, KlajnerS, Castro LP, et al. Sleeve gastrectomy with transit bipar-tition: a potent intervention for metabolic syndrome andobesity. Ann Surg. 2012; 256:104-10. 30.Sánchez-Pernaute A, Rubio MÁ, Cabrerizo L, Ramos-LeviA, Pérez-Aguirre E, Torres A. Single-anastomosis duode-noileal bypass with sleeve gastrectomy (SADI-S) for obesediabetic patients. Surg Obes Relat Dis. 2015, 11:1092-8