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Dr. Monica Nannipieri Dipartimento di Medicina Clinica e Sperimentale Università di Pisa

Dr. Monica Nannipieri Dipartimento di Medicina Clinica e Sperimentale Università di Pisa. Cumulative Incidence of T2DM. Sjostrom L, J Int Med 2012. Cumulative Incidence and Remission of T2DM. Sjostrom L, J Int Med 2012. Surgical treatment effect on indicated end-point.

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Dr. Monica Nannipieri Dipartimento di Medicina Clinica e Sperimentale Università di Pisa

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  1. Dr. Monica Nannipieri Dipartimento di Medicina Clinica e Sperimentale Università di Pisa

  2. Cumulative Incidence of T2DM Sjostrom L, J Int Med 2012

  3. Cumulative Incidence and Remission of T2DM Sjostrom L, J Int Med 2012

  4. Surgical treatment effect on indicatedend-point Sjostrom L, J Int Med 2012

  5. Cumulative Incidence of type 2 Diabetes over 15 years Sjoholm K, Diabetes Care 2013

  6. Metabolic Surgery for type 2 diabetes with BMI<35 kg/m2 Shimizu H, J Obes 2012

  7. Clinical outcomes of diabetes according to duration ofT2DM prior to surgery. Shimizu H, J Obes 2012

  8. Metabolic Surgery for type 2 diabetes with BMI<35 kg/m2Randomized trials ASMBS Clinical Issue Committee, Surg Obes Rel Dis 2013

  9. How Important Is Weight Loss in the Resolutionof Diabetes by Bariatric Surgery in Individualswith BMI <35 kg/m2? Lebovitz HE, Obes Surg 2013

  10. Recurrence of Diabetes After Metabolic SurgeryInduced Remission Lebovitz HE, Obes Surg 2013

  11. Conclusions International DiabetesFederation position statement 2011: “Surgeryshouldbeanacceptedoption in people whohave T2DM and BMI of 35 more. Surgeryshouldbeconsideredasan alternative treatment option in personswith BMI 30 to 35 whendiabetescannotbeadequatelycontrolledbyoptimalmedicalregimen, especially in the presenceofother major cardiovasculardiseaseriskfactors.” Evidencefrom the recentstudies: • A shorterhistoryofdiabeteswithlessnumberofinsulinusingpatients, a betterb-cellfunctionpriortometabolicsurgeryresulted in greaterremission rate ofdiabetes. • Furthermore, BMI alone isnotanadequatemeasuretodefine the overallriskofmorbidity and mortality in patientswith T2DM. • However, thereis no strong evidencedescribing the durabilityofmetabolicsurgery in long-term follow-up.

  12. Summary and recommendations • Forpatientswith BMI30–35 who do notachievesubstantial and durableweight and co-morbidityimprovementwith non surgicalmethods, bariatricsurgeryshouldbeanavailableoptionforsuitableindividuals. • The existing cut off of BMI,whichexcludesthosewithclass I obesity, wasestablishedarbitrarilynearly 20 years ago. • Thereis no currentjustification on groundsofevidenceofclinicaleffectiveness, cost-effectiveness, ethics, or equitythatthisgroupshouldbeexcludedfromlife-saving treatment. • Gastricbanding,sleeve gastrectomy,and gastric bypass havebeenshown in RCTstobewell-tolerated and effective treatment forpatientswith BMI30–35 in the short and medium term. ASMBS Clinical Issue Committee, Surg Obes Rel Dis 2013

  13. Remission of Type 2 Diabetes When? Predictors of successful sustained euglycemia Retnakaran R, Zinman B, Diabetes, Obesity and Metabolism, 2012.

  14. GLP-1 in remittens and no-remittens pg/ml pg/ml pg/ml pg/ml Minutes Minutes Nannipieri et al submitted Diab Care

  15. GLP-1 in remittens and no-remittens

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