The Diabetes Surgery Summit Consensus Conference Recommendations for the Evaluation and Use of Gastrointestinal Surgery to Treat Type 2 Diabetes Mellitus
The Diabetes Surgery Summit Consensus Conference Recommendations for the Evaluation and Use of Gastrointestinal Surgery to Treat Type 2 Diabetes Mellitus
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DOI：
10.1097/sla.0b013e3181be34e7
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发表时间：
2010-03-01
影响因子：
9
通讯作者：
Cummings, David E.
中科院分区：
文献类型：
--
作者：
Rubino, Francesco;Kaplan, Lee M.;Cummings, David E.
目的：目的：制定胃肠道手术治疗2型糖尿病的指南，并制定进一步研究的议程。背景：越来越多的证据表明，减肥手术可以大大改善2型糖尿病。毫不奇怪，胃肠道手术现在正在全世界范围内用于治疗与肥胖相关的糖尿病，并且越来越多地用于单独治疗糖尿病。然而，手术在糖尿病治疗中的作用并没有明确的定义，既没有明确的指导方针，也没有足够的临床试验计划来评估这种“糖尿病手术”的风险和益处。“方法：一个由来自世界各地的50名投票代表组成的多学科小组聚集在罗马，意大利，参加第一届胃肠外科治疗2型糖尿病国际会议（“糖尿病外科峰会”）。在会议期间，整个小组审查和评论了现有的科学证据，以评估证据的力度并起草协商一致的声明。通过一个反复的过程，发言稿随后经过一系列讨论、辩论、编辑、重新评估，最后提交正式表决。在罗马会议之后，对达成协商一致意见的发言进行了总结，并分发给所有有表决权的代表，以供进一步投入和最后核准。然后，在第一届T2 DM介入治疗世界大会（纽约，2008年9月）上，几个科学学会的代表正式批评了这些声明。从这次讨论的输入被用来生成当前的位置statement.Results：糖尿病手术峰会（DSS）的立场声明包括临床和研究问题的建议，以及一般的概念和定义在糖尿病手术。DSS承认在精心挑选的患者中采用手术方法治疗糖尿病的合法性。例如，胃旁路术被认为是糖尿病控制不佳和体重指数>= 30 kg/m2的患者的合理治疗选择。研究手术在不太严重的肥胖和糖尿病患者中的确切作用的临床试验被认为是一个优先事项。此外，糖尿病的手术控制机制的调查，强烈鼓励，因为它们可能有助于推进糖尿病病理生理学的理解。结论：DSS共识文件体现了“糖尿病手术”的基础，并代表了一个及时的尝试，领先的学者，以改善获得合理的证据支持的手术选择，同时也防止伤害未经证实的程序不当使用。
Objectives: To develop guidelines for the use of gastrointestinal surgery to treat type 2 diabetes and to craft an agenda for further research.Background: Increasing evidence demonstrates that bariatric surgery can dramatically ameliorate type 2 diabetes. Not surprisingly, gastrointestinal operations are now being used throughout the world to treat diabetes in association with obesity, and increasingly, for diabetes alone. However, the role for surgery in diabetes treatment is not clearly defined and there are neither clear guidelines for these practices nor sufficient plans for clinical trials to evaluate the risks and benefits of such "diabetes surgery."Methods: A multidisciplinary group of 50 voting delegates from around the world gathered in Rome, Italy for the first International Conference on Gastrointestinal Surgery to Treat Type 2 Diabetes-(the "Diabetes Surgery Summit"). During the meeting, available scientific evidence was examined and critiqued by the entire group to assess the strength of evidence and to draft consensus statements. Through an iterative process, draft statements were then serially discussed, debated, edited, reassessed, and finally presented for formal voting. After the Rome meeting, statements that achieved consensus were summarized and distributed to all voting delegates for further input and final approval. These statements were then formally critiqued by representatives of several sientific societies at the 1st World Congress on Interventional Therapies for T2DM (New York, Sept 2008). Input from this discussion was used to generate the current position statement.Results: A Diabetes Surgery Summit (DSS) Position Statement consists of recommendations for clinical and research issues, as well as general concepts and definitions in diabetes surgery. The DSS recognizes the legitimacy of surgical approaches to treat diabetes in carefully selected patients. For example, gastric bypass was deemed a reasonable treatment option for patients with poorly controlled diabetes and a body mass index >= 30 kg/m(2). Clinical trials to investigate the exact role of surgery in patients with less severe obesity and diabetes are considered a priority. Furthermore, investigations on the mechanisms of surgical control of diabetes are strongly encouraged, as they may help advance the understanding of diabetes pathophysiology.Conclusions: The DSS consensus document embodies the foundations of "diabetes surgery," and represents a timely attempt by leading scholars to improve access to surgical options supported by sound evidence, while also preventing harm from inappropriate use of unproven procedures.