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Those things about diabetic weight loss surgery!

Guide: Weight loss surgery was originally used to treat patients with morbidity and obesity. Later, people observed that in addition to significant weight loss surgery, it also helps to control blood sugar. It confirms the role of weight loss surgery in type 2 diabetes treatment.

In 2009, ADA officially listed weight loss surgery in the guidelines for type 2 diabetes therapy as one of the measures for treating obesity type 2 diabetes. Later, China Type 2 Diabetes Prevention Guide also added related content of weight loss surgery. However, weighing surgery does not do it if you want to do it. You need to strictly indicate the certificate to avoid abuse. At the same time, you can do pre -surgery, surgery, and postoperative management.

Recently, China Practical Surgery Magazine released the “Guide to Chinese Obesity and Type 2 Diabetes Surgery (2019 Edition)”. This version of the guide has changed on the basis of the 2014 version of the guide. Today we will talk about this guide and weight loss surgery. Related topics.

The surgery adaptation certificate needs to be considered multiple indicators

The recommended level of surgery has positive surgery, can consider surgery, and perform surgery carefully. Whether patients can consider weight loss surgery not only depends on the weight factors, but also need to consider the patient’s abdominal obesity (waist circumference) and the accompanying disease caused by excess fat (the incidence of fat ( Metabolic disorder syndrome). For diabetic patients, type 2 diabetes and islet function reserve capabilities are required.

The latest guidelines mentioned that the surgical indication certificate of pure obese patients: (1) BMI ≥ 37.5 kg/m^2, recommended for active surgery; 32.5 ≤ BMI <37.5kg/m^2, recommended surgery; 27.5 ≤ BMI <32.5 kg/m ^2, it is difficult to control after changing lifestyle and internal medicine, and at least in line with 2 metabolic syndrome components, or complications, surgery can be considered after comprehensive evaluation. (2) Men's waist circumference ≥90cm, female waist circumference ≥85cm, refer to the central type of obesity of the imaging inspection prompt, and after a wide range of inquiry opinions of the multidisciplinary comprehensive treatment collaboration group (MDT), you can improve the recommendation level of the surgery as appropriate. (3) It is recommended that the surgery age is 16 to 65 years.

T2DM patient surgery indicator: (1) T2DM patients still have certain insulin secretion function. (2) BMI ≥ 32.5 kg/m^2, recommended for active surgery; 27.5 ≤ BMI <32.5 kg/m^2, recommended surgery; 25≤bmi <27.5 kg/m^2, it is difficult to control the lifestyle and drug treatment after changing lifestyle and drug treatment. Blood glucose, at least in line with 2 metabolic syndrome or comorbidities, and carried out surgery carefully. (3) For patients with 25≤bmi <27.5 kg/m^2, men's waist circumference ≥90cm, female waist circumference ≥85cm, and reference imaging inspection reminder central type of obesity. (4) It is recommended that the operation age is 16 to 65 years. For patients with age <16 years old, they must be discussed by MDT such as nutritional and developmental affairs departments to comprehensively evaluate the feasibility and risks, and fully inform and know the consent. The health status, combined diseases and treatment, MDT discussed, fully evaluating cardiopulmonary function and surgical tolerance, and carried out surgery after knowing the consent.

Different surgery of weight loss surgery

After decades of development, weight loss metabolic technique has developed a variety of surgery. At present, there are 4 types of standard surgery: laparoscopic Roux-Een-Y stomach wingbing (lrygb) and laparoscopic gastric cord removal. (LSG), laparoscopic regulating gastric tie (LAGB), gallbladder pancreatic diversion and duodenal transconduction (BPD-DS), of which LAGB has an inaccurate effect after surgery, and artificial straps-related complications are common. This type of surgery has exited the stage of history. Let’s compare several other surgical styles.

Laparoscopic Roux-Een-Y stomach wing (LRYGB): It is the most mature technology, the most practical number of surgery, fast results and a lot of weight loss, which can alleviate 70%of hair diabetes, which may change the stomach instead of changing the stomach The secretion of intestinal hormones is related to the impact of the duodenal inflatable on the function of islet cells. It is the preferred surgical type. However, the LRYGB surgery is likely to cause nutrition and vitamin deficiency, dump the high incidence of syndrome, and the cost of surgery is more expensive. In addition, this surgical method makes it difficult to implement gastroscopy. For patients with pre -lesions of gastric cancer, or patients with a family history of gastric cancer, they must be Choose carefully.

Laparoscopic gastrointestinal cuffling (LSG): It is a surgical method that reduces gastric volume, removes the bottom of the gastric and gastric bending, and maintains the anatomical structure of the original gastric and intestinal tract. The degree of improvement of sugar metabolism and other metabolic indicators is better, and the price is cheaper. However, this operation is irreversible, and patients do not have poor absorption, that is, patients still need more exercise, and at the same time, they cannot consume too much carbohydrates.

Biliary pancreas and duodenal transconduration (BPD-DS): It is the main formula mainly to reduce nutrient absorption. It is better than other surgery in weight loss and metabolic index control, but the operation is relatively complicated and follows it with it. The risk of the common intestinal length is shortened, the risk of nutritional deficiency increases, and the incidence of complications and mortality are higher than other surgical formulas.

Adjustment of diabetes treatment plan

For patients with diabetes that meet the weight loss surgery, the management of perioperative surgery is very important. Among them, the management of blood sugar is as follows. The patient should monitor the patient’s empty stomach, before meal, 2h after meals, and blood sugar before bedtime. Or insulin controls blood sugar. It is recommended to discontinue gwlitone, giena and DPP-4 inhibitors 24H before surgery. Blood glucose control standards follow the guidelines for surgery. Periodic blood sugar needs to be checked regularly after surgery, and blood glucose monitoring is performed in 1 month, 3 months, 6 months, and 1 year. At the same time, OGTT, serum insulin, C peptide, and serum insulin, C peptide, and 1 year are required. Examination of glycated hemoglobin.

The Management Guide of the Patients Management of the European Obesity Research Association (EASO) mentioned in the first stage of the patient management guide after weight loss surgery mentioned in the early stage of the operation, the management of patients who still need to be treated with anti -diabetic drugs after weight loss surgery should follow the management of patients with anti -diabetic drugs. Standard diabetes guidelines, in addition, (1) day 3 after surgery: the application of dual-dual-dual-dual-dual-dual-dual-dual-dual-cymbals should be restored. Considering the patient’s kidney function, the dose should be given 850 mg, 1-2 times a day. After LRYGB surgery, the bioavailability of the dual -two dual -dual -double increased by 50%, so the dose should be reduced. (2) Day 7-10 after surgery: Treatment should be given for the blood glucose value of fasting, and at least twice the blood glucose value should be detected in the morning and during the day (the target value of the morning blood glucose: 5.6-6.7mmol/L; Blood glucose value <10mmol/L). At this stage, sulfurbaus and other drugs that increase the risk of hypoglycemia should be avoided. (3) For patients with insulin during the operation after surgery, they should continue to be applied after discharge, but blood sugar is needed to strictly monitor blood sugar to avoid the occurrence of hypoglycemia.

Pay attention to nutrient deficiency after surgery

There is a lack of nutrition in the long-term complications of weight loss surgery. This is worthy of attention. In the chapters of weight loss surgery in China Type 2 Diabetes Prevention Guide, vitamins and trace nutrients need to be supplemented. It is recommended to supplement vitamin D3000U and calcium 1200- 1500mg, iron element 150-200mg, 400 μg of folic acid, vitamin B12 1000 mg, and other trace elements.

In the early stage of LRYGB and LSG (such as within 3 months), it is recommended to supplement a variety of vitamins and trace element preparations (2 times/day) in the form of oral chewing or liquid. Calcium (given by diet or calcium citrate in the form of calcium citrate), at least 3000U vitamin D (the treatment dose of 25-hydroxye vitamin D to> 30ug/L), and supplement vitamin B12 to maintain its level at the normal range Inner (non -oral method includes subordinates, subcutaneous injection, muscle injection, and orally). The total iron intake is 45 to 60mg. Before conducting biochemical examinations, the trace nutrient supplements that are supplemented by the initial replenishment should be started.

Patients with postoperative patients do not need to review vitamin B1 regularly, but when patients with rapid weight loss, continuous vomiting, or need to drink, alcoholism, kidney diseases, encephalopathy and heart failure are required, vitamin B1 is deficient and supplemented as appropriate. Patients with severe vitamin B1 deficiency (suspected diagnosis or diagnosis) should supplement vitamin B1 500mg/d by intravenous veins, and change to 250mg/d after 3 to 5D. Risk factors are lifted. The moderate lack of venous injection vitamin B1 100mg/D, a total of 7-14D.

Oral calcium citrate and vitamin D (vitamin D2 or vitamin D3) are used to prevent secondary thyroid hyperthyroidism on the premise of hypertrophic calcium. Low phosphorusmia is often caused by the deficiency of vitamin D. Patients with mild low phosphorusmia should take orally supplementing phosphate.

Nutritional anemia caused by reducing nutrient absorption (such as BPD? DS) may also be related to the lack of B vitamin, folic acid, protein, copper, selenium, and zinc. Consider the above reasons one by one.

After reducing the weight loss surgery of nutrient absorption, patients should regularly review zinc elements, and postoperative patients who occur for hair loss, heterotaceaus, taste disorders, and male low gonad hormones, erection disorders, etc. should consider zinc deficiency. The recommended intake of zinc is 8mg/d.

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There is no need to review copper regularly after weight loss. When patients with anemia, decreased neutral cell cells, spinal neuropathy and incision healing delays should be checked. The recommended intake of copper is 2mg/d.

Patients with unknown causes of anemia, fainting, persistent diarrhea, myocardial disease and metabolic bone disease occur after weight loss surgery.

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