Weight-loss surgery could be new treatment for diabetes

[MsJacquiiC]

The discovery came about by accident more than a decade ago: Weight-loss surgery often led to dramatic improvement in the control of Type 2 diabetes, often before patients left the hospital.

[Bariatric] surgery somehow alters the secretion of hormones in the gut that play a role in appetite and help process sugar normally.

Today, evidence of the connection is so solid that some doctors say surgery should be considered as a treatment for diabetes, regardless of a person's weight.

"We thought diabetes was an incurable, progressive disease," said Dr. Walter J. Pories, a professor of surgery at East Carolina University and a leading researcher on weight-loss surgery. "It ... is a major cause of amputations, renal failure and blindness. This operation takes about an hour, and two days in the hospital, and these people go off their diabetes medication. It's unbelievable."

As many as 86 percent of obese people with Type 2 diabetes find their diabetes is gone or much easier to control within days of having weight-loss surgery, according to a meta-analysis of 19 studies published earlier this year in the American Journal of Medicine (78 percent of patients with remission of diabetes and 86.6 percent with remission or improvement). But experts still aren't sure why obesity surgery helps resolve Type 2 diabetes or how long the effect might last. And they disagree on how big a role surgery should have in treating the illness.

This much is clear: Patients who have weight-loss surgery begin to lose weight rapidly, which by itself improves Type 2 diabetes, allowing diabetics to more easily control their blood glucose levels. But something else appears to be occurring as well.

There is strong evidence that surgery - especially gastric bypass surgery, which makes the stomach smaller and allows food to bypass part of the small intestine - causes chemical changes in the intestine, said Dr. Jonathan Q. Purnell, director of the Bionutrition Unit at Oregon Health & Science University.

Surgery somehow alters the secretion of hormones in the gut that play a role in appetite and help process sugar normally.

Multiple studies in humans and animals indicate that surgery triggers reductions in ghrelin, the hormone that stimulates hunger, and elevates levels of peptide YY and glucagon-like peptide-1, both of which act as appetite suppressants. Another theory is that surgery might alter the expression of genes that regulate glucose and fatty-acid metabolism.

The effect on diabetes can depend on the type of weight-loss surgery performed, said Dr. Pories, past president of the American Society for Metabolic and Bariatric Surgery. The highest rates of diabetes remission are seen in people who have gastric bypass - about 83 percent.

But diabetes also tends to resolve or improve in 50 percent to 80 percent of people who have lap-band surgery, in which a band is placed around the top of the stomach to make it smaller, Dr. Pories said.



Shari Roan (Los Angeles Times)
Source

Bariatrics The branch of medicine that deals with the causes, prevention, and treatment of obesity. The term bariatrics was created around 1965, from the Greek root baro ("weight," as in barometer), suffix -iatr ("treatment," as in pediatrics), and suffix -ic ("pertaining to"). Besides the pharmacotherapy of obesity, it is concerned with obesity surgery.

Roux-en-Y Gastric Bypass A type of gastric bypass procedure which combines restrictive and malabsorption techniques - meaning, it reduces the amount of food a patient can comfortably eat (restriction), and also reduces the amount of calories that can be digested in the small intestine (malabsorption). This combination of bariatric methods leads to greater weight loss and the roux-en-y procedure is seen as one of the best ways to treat clinically severe obesity. See WLS Videos for animated surgery technique.

Obesity Obesity results from the excessive accumulation of fat that exceeds the body's skeletal and physical standards. Obesity has been defined as a weight more than 20% above what is considered normal according to standard age, height, and weight tables, or by a complex formula known as the body mass index. According to the National Institutes of Health (NIH), an increase in 20 percent or more above your ideal body weight is the point at which excess weight becomes a health risk. CLICK HERE TO OPEN THE JOURNEY BMI CALCULATOR!

Diabetes Mellitus A disease that occurs when the body is not able to use blood glucose (sugar). Blood sugar levels are controlled by insulin, a hormone in the body that helps move glucose from the blood to muscles and other tissues. Diabetes occurs when the pancreas does not make enough insulin or the body does not respond to the insulin that is made. There are two main types of diabetes mellitus: Type 1 Diabetes and Type 2 Diabetes. All forms of diabetes have been treatable since insulin became medically available in 1921, but there is no cure.

Gastric Banding Surgery The adjustable gastric banding is a restrictive surgical procedure during which a silicone band is placed around the stomach, creating a small pouch. The band includes a balloon that is filled with a nontoxic fluid, most commonly a saline solution; periodic adjustments are performed by a healthcare professional who accesses the balloon via a subcutaneous port. Gastric band placement, unlike malabsorptive weight loss surgery (e.g. Roux-en-Y gastric bypass surgery, Biliopancreatic Diversion, and Duodenal Switch), does not cut or remove any part of the digestive system. See WLS Videos for animated surgery technique.

Glucose Also known as dextrose or grape sugar, glucose is a building block for most carbohydrates and occurs in the sap of most plants and in the juice of grapes and other fruits. Digestion causes some carbohydrates to break down into glucose. After digestion, glucose is carried in the blood and goes to body cells where it is used for energy or stored.

Metabolism All of the processes that occur in the body that turn the food you eat into energy your body can use. Exercise, food, and environmental temperature influence metabolism.

Type 2 Diabetes Previously known as "noninsulin-dependent diabetes mellitus" or "adult-onset diabetes" -- Type 2 diabetes is the most common form of diabetes mellitus. About 90 to 95 percent of people who have diabetes have type 2 diabetes. People with type 2 diabetes produce insulin, but either do not make enough insulin or their bodies do not efficiently use the insulin they make. Most of the people who have this type of diabetes are overweight. Therefore, people with type 2 diabetes may be able to control their condition by losing weight through diet and exercise. They may also need to inject insulin or take medicine along with continuing to follow a healthy program of diet and exercise. Although type 2 diabetes commonly occurs in adults, an increasing number of children and adolescents who are overweight are also developing type 2 diabetes.