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Sapunar J, Escalona A, Araya AV, Aylwin CG, Bastías MJ, Boza C, Cárcamo C, Csendes A A, Davidof F P, Funke R, Gómez P, González MI, Lahsen R, Lanzarini E, Maíz A, Mujica V, Muñoz R, Pérez G, Raimann F, Salman P, Sepúlveda M, Soto N, Villagrán R. [Consensus statement of the Chilean endocrinological society on the role of bariatric surgery in type 2 diabetes]. Rev Med Chil 2019; 146:1175-1183. [PMID: 30724982 DOI: 10.4067/s0034-98872018001001175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Diabetes Mellitus (DM) and obesity are a public health problem in Chile. Bariatric surgery is the most effective treatment alternative to achieve a significant and sustained weight reduction in patients with morbid obesity. The results of controlled clinical trials indicate that, compared to medical treatment, surgery for obese patients with DM2 allows a better control of blood glucose and cardiovascular risk factors, reduces the need for medications and increases the likelihood for remission. Consensus conferences and clinical practice guidelines support bariatric surgery as an option to treat DM2 in Class III Obesity (Body Mass Index (BMI) > 40) regardless of the glycemic control and the complexity of pharmacological treatment and in Class II Obesity (BMI 35-39,9) with inadequate glycemic control despite optimal pharmacological treatment and lifestyle. However, surgical indication for patients with DM2 and BMI between 30-34.9, the most prevalent sub-group, is only suggested. The Chilean Societies of Endocrinology and Diabetes and of Bariatric and Metabolic Surgery decided to generate a consensus regarding the importance of other factors related to DM2 that would allow a better selection of candidates for surgery, particularly when weight does not constitute an indication. Considering the national reality, we also need a statement regarding the selection and characteristics of the surgical procedure as well as the role of the diabetologist in the multidisciplinary team.
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Affiliation(s)
- Jorge Sapunar
- Departamento de Medicina Interna y Centro EPICYN, Facultad de Medicina, Universidad de la Frontera, Temuco, Chile
| | - Alex Escalona
- Clínica Universidad de los Andes, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | | | - Carmen Gloria Aylwin
- Clínica Universidad de los Andes, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - María Juliana Bastías
- Sección Endocrinología, Diabetes y Nutrición, Departamento de Medicina Interna, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | | | - Carlos Cárcamo
- Instituto de Cirugía, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | | | | | | | | | | | | | | | - Alberto Maíz
- Departamento. Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Verónica Mujica
- Facultad de Medicina, Universidad Católica del Maule, Talca, Chile
| | - Rodrigo Muñoz
- Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gustavo Pérez
- Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Félix Raimann
- Centro Integral de Obesidad y Diabetes, Servicio de Cirugía y Endoscopía, Clínica Puerto Varas, Puerto Varas, Chile
| | - Patricio Salman
- Unidad de Endocrinología, Departamento de Medicina Interna, Facultad de Medicina. universidad de Concepción. Concepción, Chile
| | - Matías Sepúlveda
- Hospital de la Dirección de Previsión de Carabineros de Chile (DIPRECA). Santiago, Chile
| | - Néstor Soto
- Unidad de Endocrinología y Diabetes, Servicio de Medicina Interna, Hospital San Borja Arriarán. Santiago, Chile
| | - Rodrigo Villagrán
- Departamento de Cirugía Bariátrica Metabólica, Clínica Bupa Antofagasta. Antofagasta, Chile
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Pollak F, Araya V, Lanas A, Sapunar J, Arrese M, Aylwin CG, Bezanilla CG, Carrasco E, Carrasco F, Codner E, Díaz E, Durruty P, Galgani J, García H, Lahsen R, Liberman C, López G, Maíz A, Mujica V, Poniachik J, Sir T, Soto N, Valderas J, Villaseca P, Zavala C. [Second Consensus of the Chilean Society of Endocrinology and Diabetes about insulin resistance]. Rev Med Chil 2015. [PMID: 26203576 DOI: 10.4067/s0034-98872015000500012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Insulin resistance is a prevalent condition commonly associated with unhealthy lifestyles. It affects several metabolic pathways, increasing risk of abnormalities at different organ levels. Thus, diverse medical specialties should be involved in its diagnosis and treatment. With the purpose of unifying criteria about this condition, a scientific-based consensus was elaborated. A questionnaire including the most important topics such as cardio-metabolic risk, non-alcoholic fatty liver disease and polycystic ovary syndrome, was designed and sent to national experts. When no agreement among them was achieved, the Delphi methodology was applied. The main conclusions reached are that clinical findings are critical for the diagnosis of insulin resistance, not being necessary blood testing. Acquisition of a healthy lifestyle is the most important therapeutic tool. Insulin-sensitizing drugs should be prescribed to individuals at high risk of disease according to clinically validated outcomes. There are specific recommendations for pregnant women, children, adolescents and older people.
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Rodriguez L, Reyes E, Fagalde P, Oltra MS, Saba J, Aylwin CG, Prieto C, Ramos A, Galvao M, Gersin KS, Sorli C. Pilot clinical study of an endoscopic, removable duodenal-jejunal bypass liner for the treatment of type 2 diabetes. Diabetes Technol Ther 2009; 11:725-32. [PMID: 19905889 DOI: 10.1089/dia.2009.0063] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Bariatric surgery is associated with the rapid improvement of type 2 diabetes (T2DM). Here we report an exploratory trial of a completely endoscopic, removable, duodenal-jejunal bypass liner (DJBL) intended to treat T2DM. METHODS Obese T2DM subjects were randomized to receive a DJBL (n = 12) or sham endoscopy (n = 6) in a 24-week study, extended up to 52 weeks. Measurements included weights, hemoglobin A1c (HbA(1c)), meal tolerance testing, fasting glucose, and seven-point glucose profiles. Subjects' diets were adjusted in the first 2 weeks to obtain similar weight loss during this period. RESULTS Subjects had baseline HbA(1c) of 9.1 +/- 1.7% and body mass index of 38.9 +/- 6.1 kg/m(2) (+/- SD). In the completer population by week 1, change in fasting glucose in the DJBL arm was -55 +/- 21 mg/dL versus +42 +/- 30 mg/dL in the sham arm (P < or = 0.05; +/- SE); the seven-point glucose profiles were reduced in the DJBL arm but not in the sham arm. Mean postprandial glucose area under the curve was reduced in the DJBL arm by 20% and increased 17% in the sham arm (P = 0.016). At week 12, HbA(1c) change was -1.3 +/- 0.9% in the DJBL arm and -0.7 +/- 0.4% in the sham arm (P > 0.05), and at 24 weeks, values were -2.4 +/- 0.7% in the DJBL arm and -0.8 +/- 0.4% in the sham arm (P > 0.05). Device migrations required endoscopic removal prior to reaching 52 weeks. CONCLUSIONS The DJBL rapidly normalized glycemic control in obese T2DM subjects, a promising development in the search for novel therapies less invasive than bariatric surgery.
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Affiliation(s)
- Leonardo Rodriguez
- Centro de Cirugía de la Obesidad, Hospital Dipreca, Las Condes, Santiago de Chile, Chile
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