Effects of Obesity Surgery on Non Insulin Dependent Diabetes Mellitus

Department of Surgery, University of California, Los Angeles, Los Ángeles, California, United States
Archives of Surgery (Impact Factor: 4.93). 11/2002; 137(10):1109-17. DOI: 10.1001/archsurg.137.10.1109
Source: PubMed


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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    • "The global trends from 2003 to 2011 show a decrease in RYGB and a marked increase in SG [11]. RYGB, which has both malabsorptive and restrictive mechanisms, promotes early remission and sustained longterm control of T2DM [12] [13]. Meanwhile, SG can also control T2DM but is believed to have a hormonal mechanism in addition to its restrictive component [14] [15]. "
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    ABSTRACT: Until recently, Roux-en-Y gastric bypass (RYGB) was the most frequently performed procedure in bariatric surgery. In the last decade, sleeve gastrectomy (SG) has emerged as a more popular, simpler, and less morbid form of bariatric surgery. This study compares the efficacy of SG and RYGB for the treatment of type 2 diabetes mellitus (T2DM). Systemic review and meta-analysis. MEDLINE, EMBASE, and the Cochrane Library were searched for entries up to December 2013. Search terms included "Sleeve gastrectomy," "Gastric bypass," and "Type 2 diabetes mellitus." The chosen articles described both "Sleeve gastrectomy" and "Gastric bypass" and included over 1 year of follow-up data. Data analysis was performed with Review Manager 5.2 and SPSS version 20. The data set is comprised of 3 retrospective clinical studies, 6 prospective clinical studies, and 2 randomized controlled trials (RCTs), which involved 429 patients in the SG group and 428 patients in the RYGB group. In nonrandomized clinical studies, SG displayed similar efficacy in remission of T2DM compared with the standard RYGB. In the RCTs, SG had a lower effect than that of RYGB. T2DM remission was not correlated with the percent of excess weight loss for either procedure. Based on the current evidence, SG has a similar effect on T2DM remission as RYGB. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Mar 2015 · Surgery for Obesity and Related Diseases
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    • "Laparoscopic sleeve gastrectomy (LSG) was introduced initially as a first stage of the biliopancreatic diversion with duodenal switch (BPDDS) for severely obese patients who were regarded as high risk surgical candidates [1]. Due to its greater efficiency [2], technical simplicity [3], and low complication rates [4], LSG has become more widely accepted as a definitive treatment for morbidly obese patients [5]. In LSG, the stomach is divided vertically, while removing most of the fundus of the stomach and preserving the continuity of the digestive tract [6]. "
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    ABSTRACT: Background. Weight loss and reduction in comorbidities can be achieved by longitudinal sleeve gastrectomy (LSG). Existing evidence suggests that LSG resolves or improves hyperlipidemia in morbidly obese patients. The aim of this study was to systematically review the effect of LSG on hyperlipidemia. Methods. A systematic literature search was conducted from English-language studies published from 2000 to 2012 for the following databases: MEDLINE, EMBASE, CINAHL, PubMed, Clinical evidence, Scopus, Dara, Web of Sciences, TRIP, Health Technology Database, Cochrane library, and PsycINFO. Results. A total of 4,211 articles were identified in the initial search, and 4,185 articles were excluded based on the exclusion criteria. Twenty-six studies met the inclusion criteria for this systematic review, involving 3,591 patients. The mean preoperative body mass index (BMI) was 48 ± 7.0 kg/m2 (range 37.2–65.3). The mean postoperative BMI was 35 ± 5.9 kg/m2 (range 26.3–49). The mean percentage of excess weight loss (EWL) was 63.1% (range 37.7–84.5), with a mean followup of 19.1 months (range 6–60). The mean levels of pre and post operative cholesterol were 194.4 ± 12.3 mg/dL (range 178–213) and 181 ± 16.3 mg/dL (range 158–200), respectively. Conclusion. Most patients with hyperlipidemia showed improvement or resolution of lipid profiles after LSG. Based on this systematic review, LSG has a significant effect on hyperlipidemia in the form of resolution or improvement in the majority of patients.
    Full-text · Article · Oct 2013 · Journal of obesity
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    • "Bariatric surgery has become an effective treatment for obesity, also reducing the onset of type 2 diabetes mellitus (T2DM) [1] as well as inducing remission [2] and reducing cardiovascular mortality and mortality in general [3] [4]. Obesity is a chronic condition characterized by elevated inflammatory markers [5] [6] [7] and is associated with nonalcoholic fatty liver disease (NAFLD) [8] [9]. "
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    ABSTRACT: Background: Obesity is characterized by liver steatosis, chronic inflammation, and increased liver enzymes, that is, gamma-glutamyltransferase (GGT) and alanine aminotransferase (ALT), markers for nonalcoholic fatty liver disease (NAFLD) and liver fat content. Increased platelet counts (PCs) are associated with inflammatory conditions and are a valuable biomarker of the degree of fibrosis in NAFLD. We investigated alterations in PC, GGT, and ALT after biliopancreatic diversion with duodenal switch (BPD-DS) and Roux-en-Y gastric bypass (RYGBP). Methods: Ten morbidly obese patients (body mass index, BMI: 53.5 ± 3.8 kg/m(2)) who underwent BPD-DS were evaluated preoperatively (baseline) and 1 year (1st followup) and 3 years (2nd followup) after surgery and compared with 21 morbidly obese patients (BMI: 42.3 ± 5.2 kg/m(2)) who underwent RYGBP. Results: Over the 3 years of followup, changes in BPD-DS and RYGBP patients (BPD-DS/RYGBP) were as follows: BMI (-44%/-24%), GGT (-63%/-52%), and ALT (-48%/-62%). PC decreased (-21%) statistically significantly only in BPD-DS patients. Conclusions: Morbidly obese patients treated by RYGBP or BPD-DS show sustained reductions in BMI, ALT, and GGT. The decrease in PC and liver enzymes after BPD-DS may reflect a more pronounced decrease of liver-fat-content-related inflammation and, as a result, a lowered secondary thrombocytosis.
    Full-text · Article · Feb 2013 · Journal of obesity
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