Patients with type 2 diabetes can now perform metabolic surgery

The Federal Council of Medicine (CFM) 2,172 / 2017 metabolic surgery as a therapeutic option for patients with type 2 diabetes mellitus (DM2) with a body mass index (BMI) between 30 kg / m2 and 34.9 kg / m2, provided that the disease has not been controlled with clinical treatment. The text has already been sent to the Federal Gazette and only comes into force after its publication.

For a long time patients with type 2 diabetes could not have access to weight-loss surgery. This is because the criteria stipulated for granting the right of the patient to be operated on were to have a body mass index of greater than 35 kg / m2 with associated diseases or above 40 kg / m2. "The BMI is no longer a segregator of inclusion and patients with major cardiovascular complications may be indicated for surgery, "says surgeon Ricardo Cohen, coordinator of the obesity and diabetes center at the Oswaldo Cruz German Hospital.

According to him, the average BMI of a person with diabetes is 30 kg / m2. In order to be able to perform the surgery, the patient must also have tried the clinical treatment for at least two years and preferably have been diagnosed with diabetes for less than 10 years. It is also indicated that the patient is within the age range of 30 to 70 years. In addition, the CFM also stipulates that it is necessary that the indication of surgery be given by two specialists in endocrinology.

Cohen explains that patients who undergo the surgical treatment may decrease the amount of medicines consumed and some may even need no more of medicines. Similarly, according to the surgeon, surgery can also reduce the risk of death from strokes or strokes. Regarding safety, Cohen says that metabolic surgery is as safe as taking a gallbladder or a uterus. "The incidence of type 2 diabetes is one of the main causes of cardiovascular accident (CVA), coronary syndrome, renal failure and blindness, and has reached in this century epidemic status. In Brazil, the number of people with diabetes in 2015, aged between 20 and 79 years, reached the mark of 14.3 million, with the expectation of reaching 23.3 million people by 2040.

Hospitals only (ICUs), multidisciplinary and multiprofessional teams experienced in the treatment of diabetes and gastrointestinal surgery, may be chosen to perform a metabolic surgery.

How metabolic surgery is performed

The metabolic operation used will be the Roux-en-Y gastrojejunal (Roux-en-Y bypass). It consists of a reduction of the stomach, thus reducing the absorption of food. The operation is performed under general anesthesia by videolaparoscopy, with between 4 to 5 small incisions ranging from 0.5 to 1.2 cm. The average length of surgery is 45 to 60 minutes. Obviously in the rare event of an intraoperative complication, these procedures may have a longer duration. The mean time of hospitalization is 48 hours.

Only in cases of contraindication or disadvantage of the DGJYR, vertical gastrectomy (VG) will be the available option. No other surgical technique is recognized for the treatment of these patients.

Post-operative

Even though some patients no longer need to take type 2 diabetes medications, medical follow-up is still necessary for the rest of their lives to avoid the return of the disease. This is because diabetes is a chronic health condition and requires multidisciplinary follow-up to maintain patient safety and quality of life,

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