Introduction
Materials and Methods
How are type 2 diabetes Mellitus, prediabetes, and metabolic syndrome defined? | |
How is diabetes remission defined? | |
What is the effect of obesity in the natural history of DM2? | |
What is the enteroinsular axis and how does it participate in the control of DM2? | |
What is the role of calorie restriction in the control of DM2? | |
What is the role of insulin resistance in the control of DM2? | |
What is the role of other factors (bile salts and microbiota) in the control of DM2? | |
What are the complications of the strict control of DM2 and how often do they occur? | |
What is the impact of the early treatment of DM2 in the appearance of complications? | |
How is metabolic surgery defined? | |
What are the complications of metabolic surgery (MS) and how frequently do they occur? | |
What is the effect of RYGB on the factors involved in the control of DM2? | |
What is the effect of SG on the factors involved in the control of DM2? | |
What is the effect of BPD on the factors involved in the control of DM2? | |
Is there superiority of any surgical procedure for the treatment of patients with DM2? | |
What is the ideal time to evaluate the results of MS? | |
What are the results of medical vs surgical treatment in obese patients with DM2? | |
What are the results of medical vs surgical treatment in DM2 non-obese patients? | |
What are the results of medical vs surgical treatment in the prevention of late complications and mortality of the obese diabetic? | |
What are the characteristics of patients with DM2 candidates for MS? | |
Which patients are not candidates for MS? | |
Indications for MS that require further analysis |
Academia Mexicana de Cirugía/Mexican Academy of Surgery | |
Academia Nacional de Medicina/National Academy of Medicine | |
Asociación Mexicana de Diabetes/Mexican Association of Diabetes | |
Asociación Mexicana de Cirugía Endoscópica/Mexican Association of Endoscopic Surgery | |
Asociación Mexicana de Cirugía General/Mexican Association of General Surgery | |
Federación Mexicana de Diabetes/Mexican Federation of Diabetes |
Results
Answers Presented and Discussed by the Panel of Experts Are as Follows
How Are Type 2 Diabetes Mellitus, Prediabetes, and Metabolic Syndrome Defined?
Diabetes diagnosis criteriaa | |
• Plasma 8-h fasting glucose ≥ 126 mg/dl (7 mmol/l), in the absence of intercurrent diseases; or | |
• Plasma 2-h fasting glucose > 200 mg/dl (11.1 mmol/l) after performing an oral glucose tolerance curve (OGTC) with 75 g of glucose pursuant to the guidelines described by the World Health Organization (WHO); or | |
• Hemoglobin A1C ≥ 6.5%, using a method certified by the National Glycohemoglobin Standardization Program (NGSP); or | |
• Patients with classic symptoms of hyperglycemia (polyuria, polyphagia, polydipsia, weight loss) or hyperglycemic crisis with random plasma glucose > 200 mg/dl. | |
Prediabetes diagnosis criteria | |
• Altered basal glucose (ABG): 8-h fasting glycemia between 100 and 125 mg/dl (5.6–6.9 mmol/l); or | |
• Glucose intolerance (GI): upon using OGTC according to WHO criteria: 2-h post-glucose load ≥ 140 and < 200 mg/dl (7.8–11.0 mmol/L); or | |
• Hemoglobin A1C ≥ 5.7–≤ 6.4%. | |
Metabolic syndrome diagnosis criteria: 3 or more of the followingb | |
• Abdominal circumference: ≥ 80 cm in women and ≥ 90 cm in men of Latin origin (cutoff points vary according to populations); | |
• Triglycerides ≥ 150 mg/dl (1.7 mmol/L); | |
• Systolic blood pressure ≥ 130 mmHg and diastolic ≥ 85 mmHg; | |
• Cholesterol HDL < 40 mg/dl (1.0 mmol/L) in men and < 50 mg/dl (1.3 mmol/L) in women; | |
• Fasting glycemia ≥ 100 mg/dl (5.6 mmol/L). |
How Is Diabetes Remission Defined?
Result | Definition |
---|---|
Complete remission | A1C < 6.0%, basal glycemia < 100 mg/dl and absence of pharmacological treatment at least in 1 year of follow-up. |
Partial remission | DM2 undiagnosed A1C (< 6.5%), basal glycemia between 100 and 125 mg/dl, and absence of pharmacological treatment at least in 1 year of follow-up. |
Prolonged remission | Complete remission that is prolonged during a 5-year minimum period. |
Improvement | A significant reduction of A1C (> 1%) or plasma fasting glucose > 25 mg/dl or decrease in A1C or plasma fasting glucose accompanied by a decrease in the requirements of antidiabetic medicines (suspension of insulin or an oral drug or half the required dose) at least of 1-year duration. |
Without change | The absence of remission or improvement as described previously. |
Relapse | Plasma fasting glucose ≥ 126 mg/dl or A1C ≥ 6.5% or need for antidiabetic medication after complete or partial remission. |
What Is the Effect of Obesity in DM2 Natural History?
What Is Enteroinsular Axis and How Does It Participate in the Control of DM2?
What Is the Role of Caloric Restriction in the Control of DM2?
What Is the Role of Insulin Resistance (IR) in the Control of DM2?
What Is the Role of Other Factors (Bile Salts and Microbiota) in the Control of DM2?
What Are the Complications of the Strict Control of DM2 and how Often Do they Occur?
What Is the Impact of the Early Treatment of DM2 in the Appearance of Complications?
How Is Metabolic Surgery Defined?
What Are the Complications of MS and how Often Do They Occur?
What Is the Effect of RYGB on the Factors Involved in DM2 Control?
What Is the Effect of SG on the Factors Involved in DM2 Control?
What Is the Effect of BPD on the Factors Involved in DM2 Control?
Is There Superiority of any Surgical Procedure for the Treatment of DM2 Patients?
What Is the Ideal Time to Assess the Results of MS Surgery?
What Are the Results of Medical Vs Surgical Treatment in DM2 Obese Patients?
What Are the Results of Medical Vs Surgical Treatment of DM2 Non-Obese Patients?
What Are the Results of Medical Vs Surgical Treatment in the Prevention of Late Complications and Mortality of Obese Diabetic Patients?
What Are the Characteristics of DM2 Patients Who Are and Who Are Not Candidates for MS?
Grade classification | |
---|---|
Class III obesity (BMI ≥ 40 kg/m2), regardless of glycemic control level or the complexity of the glucose treatment regimens. | High |
Class II obesity (BMI 35–39.9 kg/m2). The indication is particularly relevant if glycemia is poorly controlled or if patients present associated comorbid phenomena that may be benefitted by the procedure | High |
Class I obesity (BMI 30–34.9 kg/m2) with poorly controlled glycemia despite changes in lifestyle and optimal medical therapy. | High |
Grade classification | |
---|---|
General contraindication for the surgical procedure | High |
Lack of commitment with long-term follow-up and with the necessary nutritional supplementation after surgery | High |
Comment | |
---|---|
Type 1 diabetes | Surgical indication in these patients should need to be based on a cost-benefit analysis, since patients may still require insulin after surgery |
Age < 16 years or > 65 years | Given the scarce evidence of the effects of MS in the extremes of age, it is not broadly recommended at present in these age groups, but it can be certainly offered to selected patients |
Positive anti-GAD, IA2, ICA antibodies | This group of patients shares the consideration of patients with Type 1 DM |
Disease duration of > 5 years and insulin requirement for > 2 years | These conditions are associated with a decrease in pancreatic reserve that may reduce the remission rate and increase the risk of relapse of the disease. However, a decision can be made based on a risk-benefit or a cost-effective analysis |