Understand the differences between surgery for type 2 diabetes and bariatric

The first aims diabetes control, while the second focuses on weight loss 

The term morbid obesity is known to refer to excessive body fat, which has consequences for health. Are those with greater than 35 kg / m² body mass index (BMI = weight / height) associated with diseases or above 40 kg / m² (normal BMI between 19 and 24.9 kg / m², overweight 25, 1-29 9 kg / m²).

Bariatric surgery, also known as bariatric surgery or most popularly stomach reduction, together with technical scientific support for the treatment of obesity and the diseases associated with excess body fat or aggravated by him as type 2 diabetes mellitus (T2DM), hypertension , osteoarthritis, infertility, sleep apnea, etc. Bariatric operations has over 40 years of safe use in Brazil and are undoubtedly the most effective forms of treatment for weight loss in the long term when clinical treatments fail.

However, a new concept has drawn attention of doctors: a malign obesity. Such individuals may have BMI from or around 30 kg / m², featuring mild obesity, but suffer from diseases aggravated by excess weight, especially diabetes and hypertension. Are cases where the severity of the associated diseases is not directly related to BMI.

Studies show that bariatric surgery may be a treatment option for people who are in this condition and can no longer control the problem only with remedies.

This suggests that it is apparently possible to be thin, but with the typical health problems of obese. It's like being skinny, but physiologically fat.

The T2DM, responsible for 90% of the 251 million cases of diabetes in the world, is one of the most serious illnesses of our time. It is estimated that 11% of the population is diabetic. Affects men and women, usually after age 30, which feature among the risk factors, especially obesity and overweight (not morbidly), since over 55% of cases are normal weight or overweight, and other factors present risk for the development of the disease, such as heredity, for example.

After all, if more than half of diabetics are not morbidly obese and there are mechanisms to control the initial disease independent of weight loss, bariatric surgery is equal to surgery for T2DM or metabolic? The answer is no!

From the identification in morbidly obese diabetics who had their blood sugar level normalized after bariatric surgery (obesity) not directly related to weight loss, but through mechanisms that act directly on T2DM, initiated a series of clinical studies to assess the feasibility of conducting this type of surgery in morbidly obese non-diabetics.

The results showed that patients with clinical conditions of deficiency in pancreatic function in producing insulin resistance of tissues to insulin action with difficulties in maintaining drug treatment, may benefit from surgical treatment, then creating the definition of metabolic surgery.

You can define that interventions on the digestive tract that has control of T2DM almost immediately postoperatively, via several direct mechanisms against the disease, initially unrelated to weight loss, are called metabolic operations, where weight loss that occurs over the long term is a great side effect.

Bariatric surgeries are those indicated for those individuals who have complications due to the heavy weight, such as joint disease, herniated discs, stomach acid reflux into the esophagus and etc. Metabolic interventions have as their primary objective the control of T2DM and its complications and has nothing to do with the BMI of the patient, but rather to the severity and inadequate control of T2DM, independent of BMI, either above or below 35 kg / m² . Metabolic surgery deals primarily with T2DM and conditions that comes along, such as hypertension, elevated cholesterol and triglycerides.

In cases of morbid obesity are important studies demonstrated the efficacy of the bariatric surgery, which reduces significantly the risk of complications of diabetes and development over the years. Only 10% of patients develop the disease during postoperative 10 and 15 years, versus 95% of non-operated following nonsurgical programs of disease control. And fundamentally, several epidemiological studies have shown a decrease of up to 92% of diabetes-related in the operated group, a follow-up of 16 years mortality.

Regarding surgery in non-obese diabetic morbidity, the results are also promising. Mortality in diabetic patients is predominantly secondary to cardiovascular complications, and about a year after surgery there is evidence of controlling the progression of vascular disease in the operated group, suggesting that correctly indicated surgery decreases mortality in type 2 diabetic patients undergoing operative treatment. Our research group is part of the consensus that preoperative BMI does not accurately reveal the severity of diabetes, its power to cause complications and disease mechanisms. Moreover, other factors such as age, gender, history of diabetes and loss of postoperative weight have not been decisive in remission.

And many studies underway in Brazil and abroad reinforce the guideline of the International Diabetes Federation (IDF, its acronym in English), which recommends surgery for patients with a BMI from 30 kg / m², provided it is diabetic or has predisposition to the disease and present cardiovascular risks. The directive, issued in March 2011, had the support of more than 200 medical institutions in 160 countries.

National and international standards restricting the indication of metabolic and bariatric surgery for patients with a BMI from 35 kg / m² with associated diseases or above 40 kg / m² without the mandatory presence of other diseases. This criterion is maintained for 20 years based on the consensus of US agency National Institutes of Health (NIH) and Brazil is set by the Federal Council of Medicine (CFM) through Resolution 1974 of 2010.

The indications for metabolic, freed from the constraints of BMI as a single parameter for indicating surgery has been expanded. The regulatory agency of the British Medical Practices (acronym NICE) 2 months ago changed its criteria for surgical indication for patients with T2DM without adequate clinical control, reducing the BMI to 30 kg / m2.

National guidelines CFM are old, based on international consensus 1991 where there was a laparoscopic surgery, less invasive, and does not know the action of operations on the digestive tract for the control of T2DM.

There is currently a joint effort of the National Society of Metabolic and Bariatric Surgery and Endocrinology to seek a new direction that may benefit patients with T2DM inadequately controlled with medication so that they have access to surgical treatment. No doubt worth the effort.