title: Integrating medical and surgical therapies to optimize the outcomes of type 2 diabetes.
abstract: Modern treatment of type 2 diabetes must rely on therapy individualization. Morbid obesity confers an independent excess of risk to diabetes. In these individuals metabolic surgery is an opportunity the physician should consider, especially at the time of the diabetes diagnosis, because of its efficacy and long-term effects. In addition to the possible remission of diabetes, bariatric surgery is also associated with reduced risk of micro- and macrovascular complications. A multidisciplinary team approach is necessary to maximize the beneficial effects and minimize the adverse events of metabolic surgery and to ensure proper follow-up based on the residual possibility of developing complications. In this regard, a consensus on definition of remission must be reached to define the residual risk after antidiabetic drug withdrawal. Finally, randomized clinical trials are deemed necessary to establish the risk-to-benefit profile of glucose-lowering agents for those patients who have remained diabetic or experience a disease relapse.
authors.affiliation: Endocrine Section, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ceccarini
authors.affiliation: Diabetes Section, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Ciccarone
authors.affiliation: Endocrine Section, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Ferruccio
authors.initials: F
authors.lastname: Santini
authors.affiliation: Diabetes Section, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. Electronic address: stefano.delprato@med.unipi.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Del Prato
mesh_terms: D050110:Bariatric Surgery / Q000379:methods*; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D004032:Diet; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D009767:Obesity, Morbid / Q000628:therapy; D010348:Patient Care Team; D018579:Patient Selection; D012008:Recurrence; D012074:Remission Induction; D040242:Risk Reduction Behavior; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents