Effects of obesity surgery on non-insulin-dependent diabetes mellitus.

Department of Surgery, Harbor-University of California, Los Angeles Medical Center, Torrance, CA 90509, USA.
Archives of Surgery (Impact Factor: 4.3). 11/2002; 137(10):1109-17.
Source: PubMed

ABSTRACT Most individuals who have non-insulin-dependent diabetes mellitus are obese. The obese population has proved a frustrating entity regarding weight loss and diabetes control. Results of medical weight loss programs, medications, and behavior therapy have proved disappointing.
Bariatric surgery is the most effective method of diabetes management and cure in the morbidly obese population. Surgical procedures to cause malabsorption provide a more dramatic effect on diabetes owing to the imparted bypass of the hormonally active foregut.
Pertinent journal articles spanning the last 40 years, as well as textbooks.
Bariatric surgical procedures have proven a much more successful method of weight loss and diabetes control in the obese population than conservative methods. These surgical procedures have proven safe with reported mortality rates of 0% to 1.5%. Bariatric operations may be divided based on the method of weight loss and effect on diabetes. The first category is restrictive and includes vertical banded gastroplasty and adjustable silicone gastric banding. These operations improve diabetes by decreasing food intake and body weight with a slowing of gastric emptying. The second category not only contains restrictive components but also elements of malabsorption. This category includes the Roux-en-Y gastric bypass and biliary-pancreatic diversion, which bypass the foregut. Although all of the surgical procedures for obesity offer improved weight loss and diabetes control compared with conservative methods, the Roux-en-Y gastric bypass and biliary-pancreatic diversion offer superior weight loss and resolution of diabetes. The more dramatic effect seen in the surgical procedures to cause malabsorption is likely secondary to the bypass of the foregut resulting in increased weight loss and elevation of the enteroglucagon level.

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    ABSTRACT: BACKGROUND: The ability of gastrointestinal surgical interventions, mainly bariatric surgery, to promote the control of type 2 diabetes, has already been well documented. AIM: To review the literature related to the effects of gastrointestinal surgery regarding type 2 diabetes, especially in relation to metabolic control and its physiopathology. METHODS: Literature was reviewed on Medline, pages on the internet, references from relevant articles and studies presented and published on the annals of the International Conference on Gastrointestinal Surgery to Treat Type 2 Diabetes, which occurred in Rome in 2007. CONCLUSIONS: Among all bariatric surgeries, biliopancreatic diversion, presented the best control rates for type 2 diabetes followed by gastric bypass and gastric banding. This control is related to weight loss and reduction on food intake. Biliopancreatic diversion and gastric bypass also presented important modifications in gut hormones. The most significant ones being: GLP-1, GIP, PYY, ghrelin, leptin, IGF-1, adiponectin. These hormones promote loss of appetite, promote actions over ß cells, increase the secretion of insulin, and increase insulin sensitivity. Two theories have been formulated to explain the changes observed on these hormones: the foregut theory, where the bypass of the duodenum and proximal jejunum avoids the secretion of an unknown factor that induces insulin resistance; and the hindgut theory, where the early presentation of food to the ileum anticipates the production of hormones that control diabetes. Recently, new promising procedures have been developed. Among them are the duodenal-jejunal bypass, ileal interposition, and intestinal resection associated to vertical gastrectomy. These new procedures are still considered experimental.
    ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo). 06/2007; 20(2):119-126.
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    ABSTRACT: Remission of diabetes is seen in more than 60% of patients after bariatric surgery. There is extensive variability in the remission rates between different surgical procedures. We analyzed our database and aimed to develop an easy scoring system to predict the probability of diabetes remission after two surgical procedures i.e. Ileal Interposition coupled with Sleeve Gastrectomy (IISG) or Diverted Sleeve Gastrectomy (IIDSG). In this retrospective study, we analyzed records pertaining to patients who underwent IISG (n = 46) and IIDSG (n = 29). The primary outcome measure was diabetes remission (A1c <6.5% and not requiring hypoglycemic drugs). We identified seven preoperative clinical variables (age, duration of diabetes, body mass index, micro and macrovascular complications, use of insulin and stimulated C-peptide) based on our previous reports to be included in the diabetes remission score (DRS). The DRS score (7 - 14) was compared between the patients with and without remission in both the surgery groups. Mean DRS in patients who underwent IISG was 9.2 ± 1.4. Twenty one (46%) had a remission in diabetes. DRS was significantly lower in patients with remission than patients without remission (8.1 ± 0.8 versus 10.2 ± 0.9, p < 0.0001). Mean DRS in patients who underwent IIDSG was 10.4 ± 1.3. Twenty one (72%) had a remission in diabetes. DRS was significantly lower in patients with remission than patients without remission (9.7 ± 0.8 versus 12.0 ± 0.5, p < 0.0001). Patients with a DRS ≥ 10 in IISG group and more than 12 in IIDSG group did not get into remission. Preoperative DRS can be a useful tool to select the type of surgical procedure and to predict the postoperative diabetes remission. NCT00834626.
    Journal of diabetes and metabolic disorders. 01/2014; 13(1):89.
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    ABSTRACT: The prevalence of obesity around the world has risen dramatically in the last 20 years and Costa Rica is following this trend. Body mass index is still the most widely used measuring unit used to define obesity. Obesity is associated with several medical conditions and every day it is associated with new ones including cancer and heart failure all of which will increase morbidity and mortality in these patients. Body weight regulation is not just determined by energy expenditure and consumtion but there are several endocrine signals that will determine body weight and composition. Our view of the treatment of obesity should change and recognize it and treat it as a chronic disease with maintenance of lifestyle modifications and pharmacological treatment over the years. Nowadays we have treatment that will not only produce weight loss but will also reduce the incidence of diabetes mellitus and cardiovascular disease.
    Acta médica costarricense 10/2004; 46:07-14.


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