Bases fisiopatológicas de las modificaciones endocrino metabólicas post-cirugía bariátrica en diabetes tipo 2
DOI:
https://doi.org/10.47196/diab.v50i3.44Palabras clave:
cirugía bariátrica, obesidad, derivación gástrica, diabetes mellitusResumen
Cuando la diabetes mellitus tipo 2 (DM2) se asocia a obesidad mórbida, frecuentemente la eficacia a largo plazo de las intervenciones terapéuticas no logran los objetivos ni disminuyen el riesgo cardiovascular o las complicaciones crónicas. Datos emergentes postulan a la cirugía bariátrica como tratamiento efectivo para la obesidad y sus comorbilidades.
El objetivo del presente trabajo es investigar sobre esta nueva alternativa terapéutica de la DM2 analizando desde la fisiopatología hasta los predictores de suceso y fracaso en los resultados post-quirúrgicos.
La reorganización intestinal post-quirúrgica produciría modificaciones hormonales en los ácidos biliares, sensado de nutrientes, microbioma intestinal, incretinas y anti-incretinas, asignándose un rol clave como responsable de los efectos normoglucemiantes. No obstante, la fisiología y los mecanismos moleculares subyacentes aún no se comprenden totalmente. Numerosos ensayos clínicos aleatorios a corto/mediano plazo demuestran que la cirugía metabólica logra un excelente control glucémico y reduce factores de riesgo cardiovascular. Aunque se necesitan estudios adicionales para demostrar beneficios a largo plazo, existe suficiente evidencia que apoya su inclusión entre las intervenciones contra la DM2. Una mejor comprensión de esta constelación de factores que intervienen en la homeostasis glucémica abre el camino hacia potenciales dianas terapéuticas, incluyendo drogas específicas, técnicas menos invasivas, optimización de los resultados quirúrgicos y fundamentalmente promover una mayor individualización de la terapia en la DM2.
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