Old Treatments for Weight Loss are New for Diabetes

Approximately 22% of adults in the United States and 35% of the adults in Mexico have been diagnosed with Type 2 Diabetes, which is the type that also accounts for 95% of all Diabetes cases.  About 60% of obese patients have Metabolic Syndrome (Type 2 Diabetes, High Blood Pressure and High Cholesterol) and 20% of people over 65 years are Diabetic in the US.  With an estimated over 300 million affected individuals by 2025, the lifetime risk of developing type 2 Diabetes will approximate 20%.

There is an increased interest world-wide for surgical procedures that improve Type 2 Diabetes and Metabolic Syndrome.  Many Bariatric or Weight Loss Surgeons are asked about their experience in this matter for the better understanding and treatment of this disease.  We now know after years of Gastrointestinal Weight Loss procedures, that there are two main effects achieved through bariatric surgery: one is the Bariatric Effect (successful weight loss), and the second is the Metabolic Effect (a positive change in features of Metabolic Syndrome).

People that are overweight or obese will see improvement in blood sugar levels when they lose weight. Except with the Gastric Band, other gastrointestinal weight loss procedures (Gastric Bypass, Duodenal Bypass, Gastric Sleeve, Duodenal Switch or Bilio-Pancreatic Diversion) can promote an improvement in blood sugar levels long before there is significant weight loss.  Often the improvement can be seen just days after the surgery.

Improvement of blood sugar levels for people with type 2 Diabetes can be very successful for those that receive the Gastric Band (50% of the cases), the Gastric Bypass (70%), the Gastric Sleeve (85%) or the Duodenal Exclusion Procedures with or without Sleeve (92%). Patients that need insulin, and those that have been Diabetic for a longer period of time, are more resistant to blood sugar improvements.  However, the gastric procedures have still been shown to help these patients.

There are different explanations about the Metabolic Effect.  In the gastric bypass, this effect is related to the nature of the malabsortive procedures. The Duodenal exclusion is related to the secretion changes of the Ghrelin Factor (Hunger Factor) and other Neuro-hormonal factors called Incretins as the GIP (gastric inhibitory peptide), GLP-1 (glucagon like peptide) and the YY peptide. In operated patients where the stomach and the duodenum are excluded, the increase in Incretin secretion has a direct effect on lowering the Sugar Insulin Resistance, promoting the Growth of the BETA Pancreatic Cells that produces insulin and also for the improvement of the sugar-insulin action.  For individuals with a BMI 35 or less, we observed lower weight loss with the malabsortive procedures, but the metabolic effect remained the same as seen in heavier patients.  This indicates that the procedures are very effective for improving blood sugar levels.  In the Gastric Sleeve, the effect is related to the removal of 80% of the stomach. 

Both obese patients and those with Type 2 Diabetes should discuss with the surgeon each procedure’s surgical risk, the rate of bariatric and metabolic effect, and the long-term co-morbidities that each surgical option has before deciding on any of them.

Dr. Arturo Rodriguez
http://www.thebariatric.com

Originally posted 2008-05-19 19:15:45. Republished by Blog Post Promoter