Svensk Kirurgi 4-16

218 SVENSK KIRURGI • VOLYM 74 • NR 4 • 2016 Nya rön medicinering hos typ II diabetiker (högsta evidensvärde 1A). • Den goda effekten av metabol- kirurgi på typ II diabetes gör att operation bör övervägas redan vid BMI 30kg/m2 på västerlänningar och 27,5 på asiater, om blodsock- erkontrollen är otillfredsställande. • Vid BMI 40 (37,5 för asiater) rekommenderas metabol kirurgi även vid välkontrollerat blod- socker. • Studier har visat att patienter med BMI under 35 har lika god effekt på sin typ II diabetes som de med BMI över 35. • Av de vanligaste operationsmeto- derna har duodenal switch bäst effekt på diabetes, följt av gastric bypass och därefter gastric sleeve.  Referenser 1. Rubino F. Nathan DM, Eckel RH, et al. Metabolic Surgery in the Treatment Algo- rithm for Type 2 Diabetes: A Joint State- ment by International Diabetes Organi- zations. Diabetes Care 2016; Jun; 39 (6): 861-877. Fritt tillgänglig på; http://care. diabetesjournals.org/content/39/6/861 2. O. Leyton. Diabetes and operation: A note on the effect of gastro-jejunostomy upon a case of mild diabetes mellitus with a low renal threshold. Lancet 1925. Volume 206, No. 5336, p1162–1163, 5 December; Originally published as Volume 2, Issue 5336 3. Pories WJ1, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995 Sep;222(3):339-50; discussion 350-2 4. Rubino F. Medical research: Time to think differently about diabetes. Nature. 2016 May 24;533(7604):459-61.Fritt tillgänglig på: http://www.nature.com/news/medical- research-time-to-think-differently-about- diabetes-1.19955 5. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 2012;366:1567–1576 6. Mingrone G, Panunzi S, DeGaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med 2012; 366:1577–1585 7. Mingrone G, Panunzi S,De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet 2015;386:964–973 8. Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and con- ventional therapy for type 2 diabetes: a randomized controlled trial. JAMA 2008;299:316–323 9. Schauer PR, Bhatt DL, Kirwan JP, et al.; STAMPEDE Investigators. Bariatric surgery versus intensive medical therapy for diabetesd 3-year outcomes. N Engl J Med 2014;370:2002– 2013 10. Ikramuddin S,Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA 2013;309:2240– 2249 11. Ikramuddin S, Billington CJ, Lee WJ, et al. Roux-en-Y gastric bypass for diabetes (the Diabetes Surgery Study): 2-year outcomes of a 5-year, randomised, con- trolled trial. Lancet Diabetes Endocrinol 2015;3:413–422 12. Courcoulas AP, Goodpaster BH, Eagleton JK, et al. Surgical vs medical treatments for type 2 diabetes mellitus: a randomized clinical trial. JAMA Surg 2014;149:707– 715 13. Courcoulas AP, Belle SH, Neiberg RH, et al. Three-year outcomes of bariatric surgery vs lifestyle intervention for type 2 diabetes mellitus treatment: a randomized clinical trial. JAMA Surg 2015;150:931– 940 14. Halperin F, Ding SA, Simonson DC, et al. Roux-en-Y gastric bypass surgery or lifest- yle with intensive medical management in patients with type 2 diabetes: feasibility and 1-year results of a randomized clinical trial. JAMA Surg 2014;149:716–726 15. Liang Z, Wu Q, Chen B,et al. Effect of laparoscopic Roux-en-Y gastric bypass surgery on type 2 diabetes mel- litus with hypertension: a randomized controlled trial. Diabetes Res Clin Pract 2013;101:50–56 16. Wentworth JM, Playfair J, Laurie C, et al. Multidisciplinary diabetes care with and without bariatric surgery in overweight people: a randomised controlled trial. Lancet Diabetes Endocrinol 2014;2:545– 552 17. Parikh M, Chung M, Sheth S, et al. Randomized pilot trial of bariatric surgery versus intensive medical weight mana- gement on diabetes remission in type 2 diabetic patients who do NOT meet NIH criteria for surgery and the role of soluble RAGE as a novel biomarker of success. Ann Surg 2014;260:617–622; discussion 622–624 18. Ding SA, Simonson DC, Wewalka M, et al. Adjustable gastricband surgery or medical management in patients withtype 2 diabetes: a randomized clinical trial. J Clin Endocrinol Metab 2015;100:2546– 2556 19. Cummings DE, Arterburn DE, West- brook EO, et al. Gastric bypass surgery vs intensive lifestyle and medical interven- tion for type 2 diabetes: the CROSSRO- ADS randomised controlled trial. Diabe- tologia 2016;59:945– 953 20. Gloy VL, Briel M, Bhatt DL, et al. Baria- tric surgery versus non-surgical treatment for obesity: a systematic review and meta- analysis of randomised controlled trials. BMJ 2013;347: f5934 Figur 2. Tunntarmen kommunicerar med bukspottkörteln så att denna kan anpassa insulin- frisättningen efter matens innehåll. Via hormonproducerande celler i slutet av tunntarmen kan denna stimulera bukspottkörteln att bilda mer insulin . Vid en Gastric-bypass kortas matens väg genom tarmen ned vilket leder till en snabbare frisättning av det insulinfrisät- tande hormonet Glucagon-like-peptid-1 vilket förbättrar blodsockret hos typ II diabetiker. Fullständig referenslista finns hos redaktör och redaktionssekreterare.