Metabolic Surgery for the Treatment of Diabetes Mellitus Positioning of Leading Medical Associations in Mexico

Abstract

Introduction Metabolic surgery (MS) can be a useful therapeutic strategy in patients with type 2 diabetes (DM2) and obesity. Objective To define the place of MS within DM2 treatment in Mexico. Methods A committee of experts consisting of internists and surgeons representing the leading Mexican associations involved in the field was created. Each one responded to a specific question regarding mechanisms involved in controlling DM2, surgical procedures, and the indications and contraindications for MS. This document was prepared based on the presentation and discussion of such answers.Results Obesity through insulin resistance, incretins, bile salts, and intestinal microbiota plays a determining role in the appearance of DM2. MS improves glucose homeostasis by reducing weight and intake, increasing incretins, and modifying bile salts and microbiota. MS leads to remission of DM2 and reduces cardiovascular risk factors in well-selected cases. We recommend MS as a therapeutic option in DM2 and grade III obesity regardless of metabolic control and grade II and grade I obesity with poor glycemic control. MS could be considered an option in grade II obesity with good metabolic control in the presence of associated comorbidities. Gastric bypass presents the most favorable risk-benefit profile.Conclusions Current evidence endorses the inclusion of MS in the algorithm for treatment of DM2 and obesity. The therapeutic approach must be multidisciplinary at experienced centers.

Obesidad, tejido adiposo y cirugía bariátrica

“…Por esto, también se le ha llamado cirugía metabólica, ya que ayuda a controlar la diabetes tipo 2. La mejora en la homeostasis de la glucosa podría deberse a la pérdida de peso o al incremento de las incretinas o modificación de sales biliares y de la microbiota 56 , temas que se abordarán más adelante.…”

Alteration in faecal bile acids, gut microbial composition and diversity after laparoscopic sleeve gastrectomy

“…Obesity is a common metabolic disease that is increasing worldwide 1 . Bariatric surgery treats obesity and related metabolic syndromes, including obstructive sleep apnoea, diabetes, gastro-oesophageal reflux disease and orthopaedic physical dysfunction 2,3 , and has been found to be associated with reduced mean costs to the health service 4 . Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy are the two most commonly used procedures 5,6 .…”

Cirugía bariátrica en México. Características de la práctica en 2019

“…; sin embargo, consideramos que es necesario homogeneizar las características principales de los procedimientos que pudieran tener mayor repercusión en la pérdida de peso y los resultados metabólicos. [9][10][11][12] El CMCOEM trabaja activamente en la búsqueda de estandarizar dentro de lo posible las diversas intervenciones bariátricas/metabólicas y en la recopilación de datos con la finalidad de poder comparar resultados, mejorar las oportunidades de capacitación, facilitar la retroalimentación, reducir los errores y con ello, aumentar la calidad quirúrgica.…”