Dr. Monica NannipieriDipartimento 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

Sjostrom L, J Int Med 2012

Cumulative Incidence of type 2 Diabetes over 15 years

Sjoholm K, Diabetes Care 2013

Metabolic Surgery for type 2 diabetes with BMI<35 kg/m2

Shimizu H, J Obes 2012

Clinical outcomes of diabetes according to duration ofT2DM prior to surgery.

Shimizu H, J Obes 2012

Metabolic Surgery for type 2 diabetes with BMI<35 kg/m2Randomized trials

ASMBS Clinical Issue Committee, Surg Obes Rel Dis 2013

How Important Is Weight Loss in the Resolutionof Diabetes by Bariatric Surgery in Individuals

with BMI <35 kg/m2?

Lebovitz HE, Obes Surg 2013

Recurrence of Diabetes After Metabolic SurgeryInduced Remission

Lebovitz HE, Obes Surg 2013

ConclusionsInternational Diabetes Federation position statement 2011:“Surgery should be an accepted option in people who have T2DM and BMI of 35

more. Surgery should be considered as an alternative treatment option in persons with BMI 30 to 35 when diabetes cannot be adequately controlled by optimal medical regimen, especially in the presence of other major cardiovascular disease risk factors.”

Evidence from the recent studies:• A shorter history of diabetes with less number of insulin using patients, a

better -cell function prior to metabolic surgery resulted in greater remission rate of diabetes.

• Furthermore, BMI alone is not an adequate measure to define the overall risk of morbidity and mortality in patients with T2DM.

• However, there is no strong evidence describing the durability of metabolic surgery in long-term follow-up.

Summary and recommendations

• For patients with BMI30–35 who do not achieve substantial and durable weight and co-morbidity improvement with non surgical methods, bariatric surgery should be an available option for suitable individuals.

• The existing cut off of BMI,which excludes those with class I obesity, was established arbitrarily nearly 20 years ago.

• There is no current justification on grounds of evidence of clinical effectiveness, cost-effectiveness, ethics, or equity that this group should be excluded from life-saving treatment.

• Gastric banding,sleeve gastrectomy,and gastric bypass have been shown in RCTs to be well-tolerated and effective treatment for patients with BMI30–35 in the short and medium term.

ASMBS Clinical Issue Committee, Surg Obes Rel Dis 2013

Remission of Type 2 DiabetesWhen?

Predictors of successful sustained euglycemia

Retnakaran R, Zinman B, Diabetes, Obesity and Metabolism, 2012.

GLP-1 in remittens and no-remittenspg

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Nannipieri et al submitted Diab Care

GLP-1 in remittens and no-remittens