Remisión de diabetes mellitus tipo 2 a largo plazo tras cirugía bariátrica

Abstract

Overweight and obesity have become a major health problem in developed countries. In 2014, according to WHO, the obesity rate has tripled since1980́s, with 900 million people over 18years old with overweight of which 600million (13%) are obese. In Spain there is a 22,9% prevalence of obesity (BMI>30 kg/m2)with a 1.8% of morbid obesity (MO) (BMI> 40 kg/m2). Moreover, obesity is responsible of 3,4 million deaths and 3,9% life-years lost. It is also a risk factor for developing diseases such as cancer, cardiovascular disease and diabetes mellitus. Epidemiological studies have shown that obesity is a significant risk factor for type 2 diabetes mellitus. The free fatty acids derived from visceral adipose tissue impair insulin sensitivity and beta cell function (lipotoxicity), leading to metabolic syndrome and diabetes. Given the increasing prevalence of obesity worldwide, the epidemic of diabetes has become an even larger economic and social public health challenge. Long-term glycemic control of diabetes can halt the progression of the disease, prevent complications and reduce cardiovascular risks. However, there are needs that are not addressed by intensified multifactorial interventions due to the need for continual monitoring and increasing doses over time, given the progressive nature of the disease, and most diabetic patients are unable to achieve adequate glucose control with medical therapy in the long term. In contrast, bariatric surgery has been shown to induce the remission of diabetes or to reduce the need for medications with durable long-term results in morbidly obese patients, thereby providing a potentially cost-effective approach to treating type 2 diabetes mellitus. Bariatric surgery (BS) is currently considered the most effective treatment option for morbid obesity, and is associated with25-50%, lower long-term mortality rate, improves comorbidities and avoids further complications related to obesity. This surgical option is indicated in patients with a BMI> 40 kg/m2or those with BMI 35-40 kg/m2 with comorbidities (including diabetes) in whom have failed medical therapy and without contraindications...