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Use of Metabolic Surgery for the Treatment of Type 2 Diabetes

      ABSTRACT

      Diabetes currently affects more than 220 million people worldwide. This number has increased from 171 million, reported in 2000, and the World Health Organization (WHO) projects this number will reach 366 million by 2030. One of the most significant contributors to the increased prevalence of diabetes is the epidemic of obesity. According to the International Obesity Task Force and the 2002 WHO World Health Report, ~58% of diabetes globally can be attributed to a body mass index (BMI) >21 kg/m2. Increasing use of bariatric surgery for the treatment of patients with type 2 diabetes and morbid obesity has been associated with significant improvement and even remission of diabetes in post-surgical patients. This, in turn, has led to significant research into the physiological pathways involved. The current guidelines for bariatric surgery limit its use to patients with diabetes or comorbidities whose BMI is ≥35 kg/m2; however, recent studies suggest these guidelines may need to be adjusted to include patients with type 2 diabetes who have a lower BMI.

      RÉSUMÉ

      À l'heure actuelle, plus de 220 millions de personnes dans le monde souffrent de diabète. Ce nombre était de 171 millions en 2000 et, selon l'Organisation mondiale de la santé (OMS), il sera de 366 millions d'ici 2030. L'épidémie d'obésité est un des facteurs contribuant le plus à l'augmentation de la prévalence du diabète. Selon l'International Obesity Task Force (IOTF) et le Rapport sur la santé dans le monde 2002 de l'OMS, environ 58 % des cas de diabète dans le monde sont attribuables à un indice de masse corporelle (IMC) de plus de 21 kg/m²2. L'augmentation du recours à la chirurgie bariatrique pour le traitement des patients atteints de diabète de type 2 et d'obésité morbide a été associée à une amélioration significative, voire à une rémission, du diabète chez les patients opérés, ce qui a mené à des recherches considérables sur les voies physiologiques de cet effet. Les lignes directrices actuelles limitent le recours à la chirurgie bariatrique aux patients qui présentent des troubles comorbides et dont l'IMC est de 35 kg/m² ou plus, mais des études récentes donnent à penser que ces lignes directrices pourraient devoir être modifiées pour inclure les patients atteints de diabète de type 2 ayant un IMC inférieur.

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      2. Diabetes Action Now: An Initiative of the World Health Organization and the International Diabetes Federation. http://www.who.int/diabetes/actionnow/en/. Accessed on March 25, 2011.

      3. World Health Organization. Facts about obesity and overweight. http://www.who.int/dietphysicalactivity/publications/facts/obesity/en. Accessed on March 14, 2011.

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