The Joint Declaration of the ADA and AHA includes recommendations for metabolic surgery.
The American Diabetes Association and the American Heart Association have launched a joint reviewed scientific statement to outline best practices to reduce cardiovascular risk in adults with type 2 diabetes mellitus (DM2).The statement has been published in both Diabetes Care and Circulation magazines.The declaration, "update on cardiovascular disease prevention in adults with diabetes mellitus type 2 in the light of recent evidence: a scientific statement of the American Heart Association and the American Diabetes Association", includes recommendations on surgical options for the loss of loss ofweight.
The statement recognizes that bariatric surgery "is the most effective treatment for achieving significant and lasting weight loss in patients with severe obesity," and that bariatric / metabolic surgery is increasingThe DMT2.In fact, both the International Federation of Diabetes (2011) and AHA / ACC / (2014) recommend that adults with BMI & GT;30 O & GT;35, respectively, with type 2 diabetes mellitus, a bariatric surgeon should be considered for its remission.
The statement evaluates through a meta-analysis the data available for bariatric surgery including 136 studies.The weight loss results after & GT;22,000 bariatric procedures were a global average weight loss of more than 61.2% for patients who underwent the gastric band, 61.6% for those who had gastric bypass, 68.2% for patients with gastroplasty and 70, 70,1% for patients with biliopancreatic derivation or duodenal switch, or their variants.
The statement also shows that multiple observational studies have demonstrated a significant and sustained improvement of glycemia in type 2 diabetes mellitus. A meta-analysis with the participation of 19 studies and 4,070 patients reported a global rate of resolution of type 2 diabetes of the type 2 of the78% after bariatric surgery, defined as becoming non -diabetics with normal A1C without medications.
A few studies, mostly retrospective have evaluated the effect of metabolic surgery on the progression of microvascular disease such as retinopathy, nephropathy and neuropathy in type 2 diabetes mellitus. The results suggest a potential change in reduction or developmentof nephropathy after bariatric surgery.The reversal of retinal lesions are often expectacular.
One of the main concerns in relation to bariatric surgery is the safety and complication of bariatric surgery and if potential benefits exceed surgical risks.A meta-analysis of the mortality data published after bariatric surgery reported that postoperative global mortality in the first 30 days is 0.28% (n = 84.931) and the total mortality of 30 days to 2 years from 0,35% (n = 19.928).
The immediate and long -term perioperative morbidity rates for bariatric surgery are lower than one would expect for this population with medically treated comorbidities.
"Bariatric surgery can reverse or improve many processes of obesity -related diseases, including type 2 diabetes mellitus," says the document."There is currently evidence that supports the decrease in short and medium term cardiovascular diseases ... Bariatric surgery can be especially suitable for patients with type 2 diabetes mellitus and severe obesity (BMI≥35kg / m2), becauseThese patients can benefit from the improvement of obesity and significantly improves glycemic control compared toMedical treatment alone.Together, these data highlight how bariatric surgery achieves weight loss, improvement of A1C, and improve the risk factors of cardiovascular disease. "
