Metabolic surgery for the treatment of diabetes mellitus?

Matthias Blüher

Deutsche medizinische Wochenschrift (1946) 2020 Apr

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The term metabolic surgery describes the surgical therapy of metabolic diseases, which not only aims at weight reduction but more importantly on improving hyperglycemia. Following the current S3-Guidelines, metabolic surgery should be recommended to treat T2 D in patients with a BMI ≥ 40 kg/m2 and in those with BMI 35.0-39.9 kg/m2 when individual hyperglycemia treatment targets are not achieved by optimal medical therapy. Benefits of metabolic surgery. In randomized, controlled clinical trials, metabolic surgery consistently led to better outcomes on reducing hyperglycemia, body weight, macro- and microvascular diabetes complications compared to medical T2 D treatment. Metabolic surgery is associated with acute and long-term complications. Acute risks include surgical complications contributing to a perioperative mortality between 0.1-0.5 %. Long-term risks are nutritional and micronutrient deficiencies with related complications (anemia, bone demineralization, hypoproteinemia), development of addictions or increased risk of suicidality. For the majority of individuals with T2 D, metabolic surgery will not be the first treatment choice, because modern pharmacotherapies provide an effective and safe long-term treatment of diabetes. However, there are patients with T2 D which may benefit from metabolic surgery. Treatment decisions need to be based on an individual risk-benefit evaluation by a multidisciplinary team. © Georg Thieme Verlag KG Stuttgart · New York.