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Metabolic Surgery Diabetes

What Is Metabolic Surgery? Diabetes & Weight Loss Treatment

What Is Metabolic Surgery? Diabetes & Weight Loss Treatment

Metabolic syndrome is the name for a group of risk factors that increases the chance of developing heart disease , diabetes and stroke. You must have at least three metabolic risk factors to be diagnosed with metabolic syndrome. A large waistline indicating abdominal obesity or "having an apple shape." Excess fat in the stomach area is a greater risk factor for heart disease than excess fat in other parts of the body, such as on the hips. A high triglyceride level (or you're on medicine to treat high triglycerides). Triglycerides are a type of fat found in the blood. A low HDL cholesterol level (or you're on medicine to treat low HDL cholesterol). HDL sometimes is called "good" cholesterol. This is because it helps remove cholesterol from your arteries. A low HDL cholesterol level raises your risk for heart disease. High blood pressure (or you're on medicine to treat high blood pressure). Blood pressure is the force of blood pushing against the walls of your arteries as your heart pumps blood. If this pressure rises and stays high over time, it can damage your heart and lead to plaque buildup. High fasting blood sugar (or you're on medicine to treat high blood sugar). Mildly high blood sugar may be an early sign of diabetes. The treatment of Metabolic Syndrome by surgical methods is called Metabolic Surgery. Experiments were done in the last half of the 20th century to see if diseases like high lipids and cholesterol could be treated with surgical procedures such as intestinal bypass. In 1995, Dr. Walter Pories and his research team published an article titled "Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus". Since that landmark paper, much evidence has been accumulated showing that surgery can cure/imp Continue reading >>

Metabolic Surgery In The Treatment Algorithm For Type 2 Diabetes: A Joint Statement By International Diabetes Organizations

Metabolic Surgery In The Treatment Algorithm For Type 2 Diabetes: A Joint Statement By International Diabetes Organizations

BACKGROUND Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options. AIM The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D. METHODS A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005–30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28–30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee. RESULTS Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ≥40 kg/m2) and in those with class II obesity (BMI 35.0–39.9 kg/m2) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0–34.9 kg/m2 if hyperglycemia is inadequately controll Continue reading >>

How Weight Loss Surgery Helps Type 2 Diabetes

How Weight Loss Surgery Helps Type 2 Diabetes

Weight loss surgery can make a big difference for people with type 2 diabetes. For some people, blood sugar levels get back to normal after surgery. Diabetes can be cured.That could mean you need less medication or none at all. Research shows improvements in type 2 diabetes after weight loss surgery. One long-term study tracked 400 people with type 2 diabetes. Six years after bariatric surgery, 62% showed no signs of diabetes. They also had better blood pressure, cholesterol, and triglyceride levels. In comparison, only 6% to 8% of people who took medicine, but didn’t have surgery, showed similar results. If you’re thinking about it, and you’re ready to make big changes to keep up the results, you’ll want to know if it’s right for you. First, your doctor will consider two things: Is your BMI 35 or higher? Have you tried to lose weight and keep it off without success? If so, he will give you a detailed checkup and ask you questions to see if you are physically and emotionally ready for the operation and the major changes you'll need to make. (You'll need to eat a lot less and make a healthy diet and exercise part of your life forever.) Depending on your particular case, other doctors may also get involved. For instance, if you have heart disease, your cardiologist would need to approve you for surgery. There are different kinds of operations. Some help you lose weight by shrinking the size of your stomach so you feel full after small meals. Others change the way your body absorbs calories, nutrients, and vitamins. Still others do both. Get to know what’s involved with each of these: 1. Gastric bypass (also called Roux-en-Y gastric bypass) The surgeon makes a small stomach pouch by dividing the top of the stomach from the rest of it. When you eat, food goes to Continue reading >>

Metabolic Surgery: Weight Loss, Diabetes, And Beyond

Metabolic Surgery: Weight Loss, Diabetes, And Beyond

Metabolic Surgery: Weight Loss, Diabetes, and Beyond Pareek M, Schauer PR, Kaplan LM, Leiter LA, Rubino F, Bhatt DL. Metabolic Surgery: Weight Loss, Diabetes, and Beyond. J Am Coll Cardiol 2018;71:670-687. The following are key points to remember from this review about metabolic surgery: weight loss, diabetes, and beyond: This review describes the alarming rise in the worldwide prevalence of obesity and that it is paralleled by an increasing burden of type 2 diabetes mellitus (T2DM). About 4% are severely obese (body mass index [BMI] 35 kg/m2), while 1% have morbid obesity (BMI 40 kg/m2). In the United States, more than one-third of adults are obese. Assuming unaltered trends, as much as one-fifth of the world population may have obesity by 2025, and 12% will have T2DM. Metabolic abnormalities associated with obesity increase the risk of cardiovascular disease (CVD), including coronary artery disease and heart failure. Most of the deaths for which overweight is responsible can be related to CVD and T2DM. The underlying mechanisms have not been fully elucidated, but may include metabolic, hemodynamic, and inflammatory effects of having an increased adipose tissue mass. While diet and exercise for weight loss have been disappointing and generally not durable, the Look AHEAD (Action for Health in Diabetes) trial is an example of a successful lifestyle intervention program. Among overweight or obese individuals with T2DM, one-half of those assigned to intensive lifestyle intervention (calorie goal of 1200-1800 kcal daily and 175 minutes of moderate-intensity physical activity weekly) had a clinically meaningful weight loss of 5% (mean 4.7%) of their initial weight at 8 years as compared with approximately one-third of patients in the control group. Behavioral therapy to pr Continue reading >>

'historic' Guidelines On Role Of Bariatric Surgery In Diabetes

'historic' Guidelines On Role Of Bariatric Surgery In Diabetes

'Historic' Guidelines on Role of Bariatric Surgery in Diabetes Metabolic surgery, or the use of bariatric surgery with the intent to treat type 2 diabetes and obesity, should be considered as a treatment option even in patients with mild obesity if their blood glucose levels are inadequately controlled, says a group of international experts, who are backed up by diabetes organizations. In a statement that, for the first time, sets out a series of detailed recommendations on the use of surgery in type 2 diabetes, the experts from across the globe endorse metabolic surgery as an option in patients with a body mass index (BMI) of 30.0 to 34.9 kg/m2 with inadequately controlled hyperglycemia and as a recommended therapy in patients who are even more obese. Noting that metabolic surgery is "potentially cost-effective" in obese patients with type 2 diabetes, they write: "The clinical community should work together with healthcare regulators to recognize metabolic surgery as an appropriate intervention for type 2 diabetes in people with obesity and to introduce appropriate reimbursement policies." Coauthor Philip R Schauer, MD, bariatric surgeon and director of Cleveland Clinic's Bariatric & Metabolic Center, Ohio, told Medscape Medical News that the guidelines are "historic." He said: "I've seen lots of guidelines on medical care in my career, for everything from colonoscopy to guidelines on aspirin and all kinds of things, but I've never seen guidelines that have been endorsed by 45 medical organizations." I've seen lots of guidelines on medical care in my career, for everything from colonoscopy to guidelines on aspirinbut I've never seen guidelines that have been endorsed by 45 medical organizations. The statement is published in the June issue of Diabetes Care. Despite re Continue reading >>

Metabolic Surgery: Surgical Treatment For Type 2 Diabetes

Metabolic Surgery: Surgical Treatment For Type 2 Diabetes

Diabetes is a chronic metabolic disorder that occurs when the body does not produce enough insulin and/or cannot effectively use the insulin it produces (a condition referred to as "insulin resistance"). Inadequate insulin production and action lead to raised blood glucose levels (hyperglycemia), which can adversely affect various organs and tissues including the heart, kidneys and eyes. Type 2 diabetes is associated with various cardio-metabolic disorders including obesity, high blood pressure (hypertension) and increased blood cholesterol and triglycerides (dyslipidemia). Type 2 diabetes is a progressive disease, characterized by continuing deterioration of insulin secretion over time. This leads to increasing need for medication, while persistent or worsening glycemic control may increase the risk of developing diabetes complications (i.e. hearth attacks and strokes, kidney failure, eye disease and blindness etc).Although the exact underlying causes of type 2 diabetes are not yet fully understood, a number of risk factors have been identified. These include: obesity, diet, lack of physical activity, increasing age, insulin resistance, family history of diabetes and ethnicity. Bariatric surgery, however, results in dramatic improvement of type 2 diabetes, hypertension, dyslipidemia, and reduction of overall mortality. Experimental studies from our center show that the anti-diabetes effect of certain bariatric procedures, particularly gastric bypass surgery, results from mechanisms that go beyond weight loss alone. Surgical treatment of type 2 diabetes may be offered to less obese patients with excellent results. Metabolic and Diabetes Surgery The recognition that mechanisms and benefits of bariatric surgery extend beyond weight loss question the appropriateness of the Continue reading >>

What Is Metabolic Surgery?

What Is Metabolic Surgery?

Home > Opinion & blogs > What is metabolic surgery? Following his recent paper that has helped to define metabolic surgery as a broader specialty encompassing bariatric surgery, Dr Francesco Rubino argues that the term better reflects the aims and mechanisms of surgery, and could improve access to surgery for those who need it most. Bariatric surgery, from the Greek baros meaning weight, is synonymous with weight loss surgery. Yet, the benefits and mechanisms of gastrointestinal procedures extend beyond weight loss, questioning the appropriateness of a name and practice entirely based on weight-reduction. Over the past five years, the term metabolic surgery has become increasingly popular. However, despite the popularity of the nomenclature, a clear definition of metabolic surgery has not been established. In 2002, we suggested that gastrointestinal surgery could be used with the primary intent to treat type 2 diabetes - diabetes surgery. The idea derived not only from the remarkable clinical effects of bariatric surgery on diabetes, but also from the recognition that the gastrointestinal tract is a major player in the regulation of glucose homeostasis. Ensuing investigations showing that the mechanisms of action of bariatric procedures are metabolic in nature, not just mechanic, provided scientific support for the surgical treatment of type 2 diabetes. The idea has progressively gained acceptance after a landmark Diabetes Surgery Summit in 2007, two world congresses dedicated to the subject and several position statements of relevant organizations, notably the International Diabetes Federation in 2011. Metabolic and diabetes surgery, however, are often incorrectly referred to as a surgical approach to treat diabetes in low BMI patients or as a set of novel and yet exp Continue reading >>

Metabolic And Bariatric Surgery And Type 2 Diabetes

Metabolic And Bariatric Surgery And Type 2 Diabetes

Did You Know? Someone in the world dies from complications associated with diabetes every 10 seconds. Diabetes is one of the top ten leading causes of U.S. deaths. One out of ten health care dollars is attributed to diabetes. Diabetics have health expenditures that are 2.3 times higher than non-diabetics. Approximately 90 percent of type 2 diabetes mellitus (T2DM), the most common form of diabetes, is attributable to excessive body fat. If current trends continue, T2DM or pre diabetic conditions will strike as many as half of adult Americans by the end of the decade. (according to the United HealthGroup Inc., the largest U.S. health insurer by sales). The prevalence of diabetes is 8.9 percent for the U.S. population but more than 25 percent among individuals with morbid obesity. Metabolic and bariatric surgery is the most effective treatment for T2DM among individuals who are affected by obesity and may result in remission or improvement in nearly all cases. Type 2 Diabetes Mellitus (T2DM) Type 2 diabetes(T2DM) is the most common form of diabetes, accounting for approximately 95 percent of all cases. Obesity is the primary cause for T2DM and the alarming rise in diabetes prevalence throughout the world has been in direct association increase rates of obesity worldwide. T2DM leads to many health problems including cardiovascular disease, stroke, blindness, kidney failure, neuropathy, amputations, impotency, depression, cognitive decline and mortality risk from certain forms of cancer. Premature death from T2DM is increased by as much as 80 percent and life expectancy is reduced by 12 to 14 years. Current therapy for type 2 diabetes includes lifestyle intervention (weight-loss, appropriate diet, exercise) and anti-diabetes medication(s). Medical supervision and strict adh Continue reading >>

Center For Metabolic And Weight Loss Surgery

Center For Metabolic And Weight Loss Surgery

Diabetes is a complex disease which results from the body’s inability to create or properly use insulin. A hormone produced by the pancreas, insulin, helps the body convert sugar, starches, and other food into energy. If the body doesn’t make enough insulin or if the insulin doesn’t work the way it should, glucose (sugar) cannot enter into the body’s cells. Instead, glucose remains in the bloodstream, raising the blood sugar level and ultimately causing diabetes. If not managed properly, diabetes can become a life threatening disease. People with diabetes face higher risks for heart disease, kidney failure, blindness, amputations, and other conditions. People suffering from diabetes are twice as likely to die prematurely than those who do not have it. Types of Diabetes Type 1 Diabetes Formerly called juvenile diabetes, type 1 diabetes is an autoimmune disease that results from the body’s failure to produce insulin. The disease occurs when the body’s own immune system destroys the pancreatic cells that produce insulin. Type 1 diabetes usually develops before age 20 and is typically first diagnosed in children, teenagers, or young adults. This form of diabetes accounts for about 10% of all diabetes cases. Type 2 Diabetes Accounting for about 90% of cases, type 2 diabetes used to be called adult-onset diabetes. Type 2 diabetes results from insulin resistance, a condition in which the body fails to properly use insulin. This form of diabetes is often associated with being overweight or obese. While type 2 diabetes typically develops during adulthood, the increase in childhood obesity rates has led to a growing number of children with type 2 diabetes. Gestational Diabetes A less common form of the disease is gestational diabetes, which strikes about 4% of all pre Continue reading >>

Metabolic Surgery: Weight Loss, Diabetes, And Beyond - Sciencedirect

Metabolic Surgery: Weight Loss, Diabetes, And Beyond - Sciencedirect

Volume 71, Issue 6 , 13 February 2018, Pages 670-687 Metabolic Surgery: Weight Loss, Diabetes, and Beyond Get rights and content The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus. Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individuals with obesity. Randomized trials have recently shown the superiority of surgery over medical treatment alone in achieving improved glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms seem to extend beyond the magnitude of weight loss alone and include improvements in incretin profiles, insulin secretion, and insulin sensitivity. Moreover, observational data suggest that the reduction in cardiovascular risk factors translates to better patient outcomes. This review describes commonly used metabolic surgical procedures and their current indications and summarizes the evidence related to weight loss and glycemic outcomes. It further examines their potential effects on cardiovascular outcomes and mortality and discusses future perspectives. Dr. Pareek has served on the advisory board of and received speakers honoraria from AstraZeneca. Dr. Schauer has served on the advisory boards of The Medicines Company, GI Dynamics, Neurotronic, and Pacira; has been a consultant for Ethicon, The Medicines Company, and Novo Nordisk; and has received research support from Ethicon, the National Institutes of Health, Medtronic, and Pacira. Dr. Leiter has received research funding from, has provided continuing medical education on behalf of, and/or has acted as an adviser to Amgen, AstraZeneca, Boehringer Ingelheim, Eisai, Eli Lilly, Esperion, GlaxoSmithKline, Janssen, Merck, Novo Nordisk, Sanofi/Rege Continue reading >>

How Can Metabolic Surgery Cure Diabetes So Fast?

How Can Metabolic Surgery Cure Diabetes So Fast?

Follow all of ScienceDaily's latest research news and top science headlines ! How can metabolic surgery cure diabetes so fast? No one can explain this strange phenomenon. The majority of type 2 diabetics who undergo metabolic surgery recover from diabetes only a few days after the procedure, long before any weight loss has occurred. Now researchers plan to find out what is happening by studying both patients and pigs before and after metabolic surgery. No one can explain this strange phenomenon. The majority of type 2 diabetics who undergo metabolic surgery recover from diabetes only a few days after the procedure, long before any weight loss has occurred. Now researchers at Lund University Diabetes Center plan to find out what is happening by studying both patients and pigs before and after metabolic surgery. "Since the recovery from diabetes occurs so early, a process other than weight loss has to be behind it. If we can identify and imitate this process, it could lead to entirely new ways of treating type 2 diabetes," says Nils Wierup, one of the researchers behind the study. There is a strong correlation between being overweight or obese and type 2 diabetes, and many diabetics can recover if they lose weight, but this is not the focus of the study. Instead, the focus is on a side effect -- the astonishingly fast normalisation of the glucose homeostasis which is seen in 85 per cent of diabetics after metabolic surgery. Gastric bypass surgery means rerouting food content directly to the small intestine, bypassing the stomach. This means that portion sizes have to become smaller and weight loss in the long term becomes significant. "We don't mean that everyone with type 2 diabetes should undergo surgery, but maybe we can learn to achieve the same anti-diabetic effect Continue reading >>

Bariatric Surgery For Diabetes

Bariatric Surgery For Diabetes

New guidelines last week recommended surgery as Type 2 diabetes treatment for people who are obese, including some who are mildly obese. Is “metabolic surgery” something you should consider? The guidelines were approved by the American Diabetes Association, the International Diabetes Federation, and 43 other medical groups around the world. They were published in the June issue of the journal Diabetes Care. If you are heavy and have an HbA1c of 7.0 or above, your doctor may soon advise you to have one of these surgeries. You will be told the surgery will lower your blood sugar and your weight, which usually happens. You may not be told the negative effects. How do you decide? When performed to manage diabetes, bariatric or weight-loss surgery is known as “metabolic surgery.” The term covers Roux-en-Y “gastric bypass” surgeries, which reduce your stomach to a small pouch and plug it into the middle of the small intestine. It also includes “sleeve gastrectomy,” in which the deep part of the stomach is removed and the rest stapled together into a sleeve shape. Wrapping a band around the stomach to shrink it (“gastric banding“) is also now considered metabolic surgery. There are other surgeries that restructure the bowel in different ways, which I’ll write about next week. Surgeons have been pleased to learn that their weight-loss operations also lower blood sugars, though they are working to fully understand how that happens. It’s probably not the weight loss. Often, the improvements in diabetes numbers come long before significant weight loss occurs. A conference in Rome in 2007 reported that people were getting off their diabetes medications and lowering their HbA1c scores after surgery. Eight years later, a follow-up conference in London decided Continue reading >>

Metabolic Surgery: A Paradigm Shift In Type 2 Diabetes Management

Metabolic Surgery: A Paradigm Shift In Type 2 Diabetes Management

Metabolic surgery: A paradigm shift in type 2 diabetes management Joseph M Pappachan and Ananth K Viswanath Joseph M Pappachan, Ananth K Viswanath, Department of Endocrinology and Diabetes, New Cross Hospital, the Royal Wolverhampton Hospital NHS Trust, Wolverhampton WV10 0QP, United Kingdom Author contributions: Viswanath AK conceived the idea; Pappachan JM wrote the initial draft of the paper; both authors contributed to literature search and final preparation of the manuscript. Correspondence to: Dr. Joseph M Pappachan, MD, MRCP (London), Department of Endocrinology and Diabetes, New Cross Hospital, the Royal Wolverhampton Hospital NHS Trust, Wolverhampton Road, Wolverhampton WV10 0QP, United Kingdom. [email protected] Telephone: +44-1922-721172 Fax: +44-1922-721172 Received 2015 Apr 12; Revised 2015 Apr 30; Accepted 2015 May 27. Copyright The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved. This article has been cited by other articles in PMC. Obesity and type 2 diabetes mellitus (T2DM) are major public health issues globally over the past few decades. Despite dietary interventions, lifestyle modifications and the availability of several pharmaceutical agents, management of T2DM with obesity is a major challenge to clinicians. Metabolic surgery is emerging as a promising treatment option for the management of T2DM in the obese population in recent years. Several observational studies and a few randomised controlled trials have shown clear benefits of various bariatric procedures in obese individuals in terms of improvement or remission of T2DM and multiple other health benefits such as improvement of hypertension, obstructive sleep apnoea, osteoarthritis and non-alcoholic fatty liver disease. Uncertainties about the long-term Continue reading >>

Metabolic Surgery For Type 2 Diabetes Treatment Algorithm Guidelines | Ndei

Metabolic Surgery For Type 2 Diabetes Treatment Algorithm Guidelines | Ndei

Metabolic surgery is recommended to treat: Type 2 diabetes in patients with Class II and Class III obesity when glycemia is inadequately controlled by lifestyle and optimal medical therapy Metabolic surgery may be considered to treat: Type 2 diabetes in patients with Class I obesity if glycemic control is poor despite optimal treatment with oral or injectable medications Surgery should be performed in high-volume centers with multidisciplinary teams that understand and are experienced in the management of diabetes and GI surgery Mortality rates with bariatric/metabolic operations are typically 0.1%-0.5% Major complications rates are 2%-6%, with minor complications in up to 15 Postoperative follow-up: Ongoing and long-term monitoring of micronutrient status, nutritional supplementation, and support Short/mid-term RCTs have shown that metabolic surgery achieves excellent glycemic control and reduces CV risk factors. Surgical value is more related to improved glucose homeostasis than weight loss. Additional studies are needed to demonstrate long-term benefits. Continue reading >>

Metabolic Surgery For The Treatment Of Type 2 Diabetes In Obese Individuals.

Metabolic Surgery For The Treatment Of Type 2 Diabetes In Obese Individuals.

1. Diabetologia. 2018 Feb;61(2):257-264. doi: 10.1007/s00125-017-4513-y. Epub 2017Dec 9. Metabolic surgery for the treatment of type 2 diabetes in obese individuals. (1)Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, University of Washington, Box 358280 (mail stop 111), Seattle, WA, 98195, USA. [email protected] (2)VA Puget Sound Health Care System, Seattle, WA, USA. [email protected] (3)Department of Surgery, Diabetes and Nutritional Sciences Division, King's College London and King's College Hospital, 1st floor James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9NU, UK. [email protected] Several bariatric operations originally designed to promote weight loss have beenfound to powerfully treat type 2 diabetes, causing remission in most cases,through diverse mechanisms additional to the secondary consequences of weightloss. These observations have prompted consideration of such operations as'metabolic surgery', used expressly to treat diabetes, including among patientswho are only mildly obese or merely overweight. Large, long-term observationalstudies consistently demonstrate that bariatric/metabolic surgery is associatedwith reductions in all cardiovascular risk factors, actual cardiovascular events,microvascular diabetes complications, cancer and death. Numerous recentrandomised clinical trials, directly comparing various surgical vs non-surgicalinterventions for diabetes, uniformly demonstrate the former to be superior forimprovements in all glycaemic variables, as well as other metabolic endpoints.These benefits are similar among individuals with type 2 diabetes and apreoperative BMI of 30-35kg/m2 compared with traditional bariatric surgerypatients with a BMI >35kg/m2. The safety profil Continue reading >>

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