Tip 2 Diyabet Tedavisinde Bariyatrik Cerrahinin Yeri

ÖzBariyatrik ve metabolik cerrahiler, ağır obezitede, mantıklı bir kilo yönetimi programının parçası olarak, ömür boyu süren bir yaşam tarzı desteği ve medikal monitorizasyon ile etkili kilo kaybı tedavileri olabilirler. Bariyatrik cerrahi VKİ 35 kg/m2 ve tip 2 diyabetli, özellikle diyabet ilişkili komorbiditeleri olan ve yaşam tarzı değişikliği ve farmakolojik tedavi ile kontrolü güç olan hastalarda uygulanabilir. Bariyatrik cerrahinin mortalite, erken ve geç komplikasyon riskleri bulunmasına rağmen, direkt cerrahiye bağlı morbidite ve mortalite ciddi şekilde düşmüştür. Ancak uygun hasta, doğru cerrah ve doğru merkez ile uygun teknik seçimi çok önemlidir. Rutin tedavi kılavuzlarında yer alması içinise; uzun vadedeki sonuçların görülmesi, endikasyonların kesinleştirilmesi ve cerrahinin diyabet tedavisindeki yerinin medikal tedaviler kadar netleştirilmesine, dolayısıyla zamana ihtiyaç vardır.

Anahtar Kelimeler:

Diyabetes mellitus, bariyat-rikcerrahi, obezite

Bariatric Surgery in the Treatment of Type 2 Diabetes Mellitus

AbstractBariatric and metabolic surgeries, can be effective weightloss tools with a lifelong lifestyle support and annual medical monitoring at a minimum in morbid obesity, as asensible part of weight management program. Bariatric surgery may be considered for adults with BMI 35 kg/m2 and type 2 diabetes, especially if diabetesor associated comorbidities are difficult to control with lifestyle changes and pharmacological therapy. Although bariatric surgery has risks like mortality, early and late complications, morbidity and mortality related-to-surgery has significantly decreased. But; choosing the right patient, right surgeon and center and also appropriate technique is very important. To place bariatric surgery into routine diabetes therapy guidelines; long-term results should be seen, indications must become exact, surgery’s place in the treatment of diabetes mustbe clarified as much as medical treatments; thus more time is needed.

Keywords:

Diabetes mellitus, bariatricsurgery, obesityi,

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Kaynaklar 1.Keidar A. Bariatricsurgeryfortype 2 diabetesreversal: Therisks.DiabetesCare 2011:34(2):S361-S266. 2.Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, Top-lak H; Obesity Management Task Force of the European Associa-tion for the Study of ObesityEuropean Guidelines for Obesity Ma-nagement in Adults.Obes Facts. 2015;8(6):402-24. 3.http://www.turkendokrin.org/files/file/OBEZITE_TTK_web.pdf TEMDObezite tanı ve tedavi kılavuzu-2014 Erişim tarihi:29.02.2016 4.Taşkın M,Zengin SÜ,Taşkın HE. Bariyatrik ve metabolik cerrahinin ta-rihçesi. Türkiye Klinikleri J Gen Surg-Special Topics 2015;8(3):1-5. 5. Bilen H.Bariyatrik cerrahide hasta seçiminde endokrinolojik değer-lendirme ve endikasyonlar. Bariyatrik ve metabolik cerrahinin tarih-çesi. Türkiye Klinikleri J Gen Surg-Special Topics 2015;8(3):12-15. 6. Mihmanlı M, Işıl RG, İdiz UO. Bariyatrik Cerrahi SonuçlarınaGenel Bakış. Türkiye Klinikleri J Gen Surg-Special Topics2015;8(3):6-11. 7. Erdem NZ. Metabolik ve Bariyatrik Cerrahide Nütrisyonel ve Me-tabolik Sorunların Çözümleri. Türkiye Klinikleri J Gen Surg-Spe cial Topics 2015;8(3):98-106. 8. http://www.idf.org/sites/default/files/DA-regional-factsheets-2014_FINAL.pdf IDF Diabetes Atlas 2014 Update 6th Edition Eu-rope At A Glance Erişim tarihi:29.02.2016 9. Grams J, Garvey WT. WeightLossandthePreventionandTreatment of Type2 Diabetes Using LifestyleTherapy, Pharmacotherapy, andBariatric-Surgery: Mechanisms of Action.CurrObesRep. 2015 ;4(2):287-302. 10.Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, Mingro-ne G, et al. Bariatricsurgeryversusnon-surgicaltreatmentforobe-sity. Br J Sports Med. 2016 ;50(4):246. 11.Rubino F, Moo TA, Rosen DJ, Dakin GF, Pomp A. Diabetes sur-gery: a new approachto an olddisease.Diabetes Care.2009;32Suppl 2:S368-72 12.http://passthrough.fwnotify.net/download/581492/http://care .dia-betesjournals.org/site/misc/2016-Standards-of-Care.pdf Erişimtarihi:29.02.2016 AmericanDiabetesAssociationStandards ofMedicalCare in Diabetes 2016. Obesity Management fortheTre-atment of Type 2 Diabetes. DiabetesCare2016 39(1): 47-51. 13.Sjostrom L, Peltonen M, Jacobson P, et al. Association of bariatric-surgerywithlong-termremission of type 2 diabetesandwithmicrovas-cularandmacrovascularcomplications.JAMA 2014;311:2297–2304. 14. Schauer PR, Bhatt DL, Kirwan JP, et al.;STAMPEDEInvestiga-tors. Bariatricsurgeryversusintensivemedicaltherapyfordiabe-tesd 3-year outcomes. N Engl J Med 2014;370: 2002–2013. 15. Still CD, Wood GC, Benotti P, et al. Preoperativeprediction of type2 diabetesremissionafterRoux-en-Y gastric bypass surgery: a ret-rospectivecohortstudy. LancetDiabetesEndocrinol 2014;2:38–45. 16. Omotosho P, Mor A, Shantavasinkul PC, Corsino L, Torquati A. Gas-tric bypass significantlyimprovesquality of life in morbidlyobesepati-entswithtype 2 diabetes.SurgEndosc. 2016 Jan 28. [Epubahead of print] 17. Brethauer SA, Aminian A, Rosenthal RJ, Kirwan JP, Kashyap SR, Scha-uer PR. Bariatricsurgeryimprovesthemetabolicprofile of morbidlyo-besepatientswithtype 1 diabetes. DiabetesCare 2014; 37:e51–e52. 18. Faucher P, Poitou C, Carette C, TezenasduMontcel S, Barsami-an C, Touati E, et al. BariatricSurgery in ObesePatientswithTy-pe 1 Diabetes: Effects on WeightLossandMetabolicControl.Obes-Surg. 2016 Feb 17. [Epubahead of print] 19. Ashrafian H, Harling L, Toma T, Athanasiou C, Nikiteas N, EfthimiouE, et al. Type 1 DiabetesMellitusandBariatricSurgery: A SystematicR-eviewand Meta-Analysis.ObesSurg. 2015 Dec 22. [Epubahead of print] 20. Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I. Trends inmortality in bariatricsurgery: a systematicreviewand meta-analy-sis. Surgery 2007;142:621–632. 21. TheLongitudinalAssessment of BariatricSurgery (LABS) Consor-tium. Peri-operativesafety in thelongitudinalassessment of bari-atricsurgery. N Engl J Med 2009;361:445–454. 22. Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I. Surgery.Trends in mortality in bariatricsurgery: a systematicreviewand meta-analysis.2007;142(4):621-632. 23. Maciejewski ML, Livingston EH, Smith VA, et al. Survivalamong-high-risk patientsafterbariatricsurgery. JAMA 2011;305:2419–2426. 24. Hoerger TJ, Zhang P, Segel JE, Kahn HS, Barker LE, Couper S.Cost-effectiveness of bariatricsurgeryforseverelyobeseadults-withdiabetes. DiabetesCare 2010;33:1933–1939. 25. Keating CL, Dixon JB, Moodie ML, Peeters A, Playfair J, O’Bri-en PE. Cost-efficacy of surgicallyinducedweightlossforthemana-gement of type 2 diabetes: a randomizedcontrolledtrial. Diabe-tesCare 2009;32:580–584.26. Wolfe BM, Belle SH. Long-termrisksandbenefits of bariatricsur-gery: a researchchallenge. JAMA 2014;312:1792–1793. 27.Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C,Carlsson B, Dahlgren S, Larsson B, Narbro K, Sjöström CD, Sul-livan M, Wedel H; SwedishObeseSubjectsStudyScientificGroup.NEngl J Med.Lifestyle, diabetes, andcardiovascular risk factors 10yearsafterbariatricsurgery. 2004;351 (26):2683-93. 28.Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A,NanniGet.al. Bariatric-metabolic surgery versusconventionalme-dicaltreatment in obesepatientswithtype 2 diabetes: 5 yearfollow-up of an open-label, single-centre, randomisedcontrolledtrialLan-cet. 2015 5;386(9997):964-973. 29.Maleckas A, Venclauskas L, Wallenius V, Lönroth H, Fändriks L.Surgery in thetreatment of type 2 diabetesmellitus.Scand J Surg.2015 ;104(1):40-47. 30.Chen Y, Corsino L, Shantavasinkul PC, Grant J, Portenier D, DingL, et al. Gastric Bypass Surgery Leads to Long-term Remissionor Improvement of Type 2 Diabetes and Significant Decrease ofMicrovascular and Macrovascular Complications.Ann Surg.2015 Nov 6. [Epub ahead of print] 31.Taşkın M, Zengin K, Taşkın HE, Türkmen ÖU. Diyabetin Cerra-hi Tedavisi. turkishobesitysurgery.com. Erişim tarihi: 8.3.2016 32.Dicker D, Yahalom R, Comaneshter DS, Vinker S. Long-TermOutco-mes of Three Types of Bariatric Surgery on ObesityandType 2 Diabe-tes Control andRemission.ObesSurg. 2015 Dec 30. [Epubahead of print] 33. Dadson P, Landini L, Helmiö M, Hannukainen JC, Immonen H,Honka MJ, et al. Effect of BariatricSurgery on AdiposeTissueG-lucoseMetabolism in DifferentDepots in PatientsWithorWithoutTy-pe 2 Diabetes.DiabetesCare. 2016 ;39(2):292-9. 34.Seki Y, Kasama K, Umezawa A, Kurokawa Y. LaparoscopicSlee-veGastrectomywithDuodenojejunal Bypass forType 2 Diabetes-Mellitus.ObesSurg. 2016 Jan 9. [Epubahead of print] 35. Sharma AM.At 15 years of follow-up, bariatric surgery, especi-ally when performed within the first year, is associated with dia-betes remission and reduced incidence of microvascular and mac-rovascular complications.Evid Based Med. 2014;19(6):220. 36.Sarosiek K, Pappan KL, Gandhi AV, Saxena S, Kang CY, McMa-hon H, et al. ConservedMetabolicChanges in NondiabeticandTy-pe 2 DiabeticBariatricSurgeryPatients: Global MetabolomicPilot Study.J DiabetesRes. 2016;2016:3467403. 37.Keidar A. Bariatricsurgeryfortype 2 diabetesreversal: Therisks.DiabetesCare2011:34(2):S361-S26. 38. Sharma R, Hassan C, Chaiban JT. SevereInsulinResistanceImpro-vesImmediatelyAfterSleeveGastrectomy.J InvestigMed High Im-pact Case Rep. 2016 5;4(1):2324709615625309. 39. HaJ, Satin LS, Sherman AS. A Mathematical Model of thePatho-genesis, Prevention, andReversal of Type 2 Diabetes.Endocrino-logy. 2016 ;157(2):624-35. 40. Michalik M, Bobowicz M, Buchwald H. A numerical scale to as-sess the outcomes of metabolic/bariatric surgery (NOMS).Wide-ochirInne Tech Maloinwazyjne. 2015;10(3):359-62. 41. Cordera R, Adami GF. Frombariatrictometabolicsurgery: Looking-for a "diseasemodifier" surgeryfortype 2 diabetes.World J Diabe-tes. 2016 ;7(2):27-33.