Question by Crain MD: How does gastric bypass surgery cure diabetes? Please help?
Im giving a presentation next monday on the topic that gastric bypass surgeries such as the roux-en-Y and the duodenal switch are proven to cure or reverse diabetes. I have found some therioes on possible explanations of how this is possible but wanted to see if anyone could come up with some others through articles. Any help i would greatly appreciate
Answer by BioLiz
Looking at your avatar name you might be an MD, so I am probably not telling you anything new by saying that there are 2 types of diabetes; type 1, in which the insulin production is decreased, and type 2 (“adult onset”), in which the response of the body to insulin is decreased. Type 2 is the type associated with obesity, and it is known that even modest weight loss can restore insulin sensitivity.
I am not an MD, nor a specialist in diabetes, but according to Wikipedia (for what that’s worth), certain types of gastric bypass surgery have a high success rate in reverting diabetes type 2. Folli et al. Med Clin North Am 91:393-414.
Although it was first believed that weight loss would be the main cause of the effectiveness of gastric bypass surgery, there is now increasing evidence that the removal of duodenum and other intestinal parts might be responsible.
Here is a couple of recent studies and reviews that should be able to help you further:
1: Isr Med Assoc J. 2008 May;10(5):350-3.
Laparoscopic Roux-en-Y gastric bypass for the treatment of morbid obesity:
experience with 50 patients.
Khalaileh A, Matot I, Schweiger C, Appelbaum L, Elazary R, Keidar A.
Department of General Surgery, Hadassah-Hebrew University Medical Center,
BACKGROUND: Roux-en-Y gastric bypass is currently considered the gold standard
surgical option for the treatment of morbid obesity. Open RYGB is associated with
a high risk of complications. Laparoscopic RYGB has been shown to reduce
perioperative morbidity and improve recovery. OBJECTIVES: To review our
experience with laparoscopic RYGB during a 19 month period. METHODS: The data
were collected prospectively. The study group comprised all patients who
underwent laparoscopic RYGB for treatment of morbid obesity as their primary
operation between February 2006 and July 2007. The reported outcome included
surgical results, weight loss, and improved status of co-morbidities, with
follow-up of up to 19 months. RESULTS: The mean age of the 50 patients was 36.7
years. Mean body mass index was 44.7 kg/m2 (range 35-76 kg/m2); mean duration of
surgery was 171 minutes. There was no conversion to open surgery. The mean length
of stay was 4 days (range 2-7 days). Five patients (10%) developed a
complication, but none of them required early reoperation and there were no
deaths. Mean follow-up was 7 months (range 40 days-19 months). The excess body
weight loss was 55% and 61% at 6 and 12 months respectively. Diabetes resolved
completely or significantly improved in all five patients with this condition, as
did hypertension in eight patients out of nine. CONCLUSIONS: Laparoscopic RYGB is
feasible and safe. The results in terms of weight loss and correction of
co-morbidities are comparable to other previously published studies. However,
only surgeons with experience in advanced laparoscopic as well as bariatric
surgery should attempt this procedure.
1: J Am Diet Assoc. 2008 Apr;108(4 Suppl 1):S40-4.
Obesity surgery: evidence for diabetes prevention/management.
Cummings S, Apovian CM, Khaodhiar L.
MGH Weight Center, Massachusetts General Hospital, Boston, MA 02114, USA.
Obesity is associated with an increased risk of developing insulin resistance and
type 2 diabetes. Development of type 2 diabetes can be delayed or sometimes
prevented from manifestation in individuals with obesity that are able to lose
weight. Weight loss can be achieved either medically with behavioral therapies
that combine diet and exercise treatment or with behavioral therapies combined
with weight-loss medications or weight-loss surgery. There is strong evidence of
an amelioration or resolution of type 2 diabetes in patients undergoing gastric
bypass surgery. A recently published retrospective cohort study indicated that
long-term total mortality from diabetes, heart disease, and cancer after gastric
bypass surgery was substantially reduced. In this review, we summarize the
evidence of surgical interventions in the treatment of type 2 diabetes.
: Curr Opin Endocrinol Diabetes Obes. 2008 Apr;15(2):153-8.
Gastrointestinal surgery as treatment for type 2 diabetes.
Moo TA, Rubino F.
Weill Cornell Medical College of Cornell University-New York Presbyterian
Hospital, New York, New York 10065, USA.
PURPOSE OF REVIEW: As the incidence of type 2 diabetes continues to rise
worldwide at epidemic proportions, endeavors to find more effective therapies
increase. Gastrointestinal bypass surgery is now gaining awareness as a potential
effective and long-term treatment. RECENT FINDINGS: There is now a substantial
body of evidence supporting the efficacy of gastrointestinal surgery in
controlling type 2 diabetes. This is well documented in several studies of obese
diabetic patients undergoing gastrointestinal bypass procedures. Additionally,
smaller studies and case reports also demonstrate the efficacy of
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