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Risks Of Bariatric Surgery For Diabetes

Bariatric Surgery For Type 2 Diabetes Reversal: The Risks

Bariatric Surgery For Type 2 Diabetes Reversal: The Risks

The twin epidemics of obesity and type 2 diabetes are on the rise. From 1986 to 2000, the prevalence of BMI 30 kg/m2 doubled, whereas that of BMI >40 kg/m2 quadrupled, and even extreme obesity of BMI 50 kg/m2 increased fivefold (1). Of particular concern is the alarming increasing prevalence of obesity among children, suggesting that the epidemic will worsen (2). The impact of obesity on longevity has been well documented. In the world, over 2.5 million deaths annually can be attributed to obesity; in the U.S. alone over 400,000 deaths attributable to obesity occur per year—second only to those attributable to cigarette smoking. There is a direct relationship between increasing BMI and relative risk of dying prematurely, as evidenced in the Nurses’ Health Study with a 100% increase in relative risk as BMI increased from 19 to 32 kg/m2. Annual risk of death can be as high as 40-fold that of an age- and sex-matched nonobese cohort (3,4). The Framingham data revealed that for each pound gained between ages 30 and 42 years there was a 1% increased mortality within 26 years, and for each pound gained thereafter there was a 2% increased mortality. Only one in seven obese individuals will reach the U.S. life expectancy of 76.9 years. In the morbidly obese population, average life expectancy is reduced by 9 years in women and by 12 years in men. It has been over 10 years since the resolution of type 2 diabetes was observed as an additional outcome of surgical treatment of morbid obesity. Moreover, it has been shown unequivocally that diabetes-related morbidity and mortality have declined significantly postoperatively, and this improvement in diabetes control is long lasting. Bypass procedures, the Roux-en-Y gastric bypass (RYGBP) and the biliopancreatic diversion (BPD), are Continue reading >>

Gastric Bypass Surgery May Lower Diabetes Risks, But Also Carries Dangers

Gastric Bypass Surgery May Lower Diabetes Risks, But Also Carries Dangers

Gastric surgery may not only help people combat obesity: Evidence shows it can also help reduce diabetes risk factors. A new University of Minnesota study published in JAMA on June 5 reveals that mild to moderately obese patients with Type 2 diabetes had more improvements in their blood glucose, cholesterol and blood pressure after they underwent gastric bypass surgery, than patients who made lifestyle changes with medical counseling. About 35.7 percent of the U.S. adult population is obese, according to the Centers for Disease Control and Prevention. Obesity has been linked to heart disease, stroke, Type 2 diabetes, some cancers and some of the leading causes of preventable death. About 25.8 million people have diabetes in the U.S. as of 2010, the NIH reports. The vast majority of those people have Type 2 diabetes, which is when the body does not produce enough insulin or the cells do not use the insulin. Insulin is produced by the pancreas and is required for a process in which the body wants to use energy from glucose, or broken down sugars and starches obtained from food. The best treatment for Type 2 diabetes is weight loss, but controlling glucose levels, blood pressure and cholesterol are important as well, the study authors noted. However, the optimal way to manage all those factors remains unknown. Researchers looked at 120 participants who had a hemoglobin A1c (HbA1c) level of 8.0 percent or higher, body mass index (BMI) between 30.0 and 39.9 signifying they were obese, a C peptide level of more than 1.0 ng/mL, and Type 2 diabetes for at least six months. The subjects were divided into two groups and followed for a year. The first group underwent Roux-en-Y gastric bypass. The second group was instructed to change their lifestyle and have intensive medical mana Continue reading >>

Bariatric Surgery For Type 2 Diabetes: Weighing The Impact For Obese Patients

Bariatric Surgery For Type 2 Diabetes: Weighing The Impact For Obese Patients

Bariatric surgery for type 2 diabetes: Weighing the impact for obese patients SANGEETA R. KASHYAP, Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic; Sangeeta Kashyap, MD, Department of Endocrinology, F20, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195; [email protected] ; Philip Schauer, MD, Bariatric and Metabolic Institute, M61, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195; [email protected] aDr. Brethauer has received research support from Bard-Davol, honoraria from Coviden for teaching and speaking, and honoraria and fees from Ethicon Endosurgery for consulting and serving on advisory committees or review panels. bDr. Schauer has received honoraria, fees, or grants from Allergan, Bard-Davol, Barosense, Baxter, Cardinal/Snowden Pincer, Coviden, Ethicon Endosurgery, Gore, Surgical Excellence LLC, and Surgiquest for various work. See other articles in PMC that cite the published article. Obesity is a potent risk factor for the development and progression of type 2 diabetes, and weight loss is a key component of diabetes management. Bariatric surgery results in significant weight loss and remission of diabetes in most patients. After surgery, glycemic control is restored by a combination of enforced caloric restriction, enhanced insulin sensitivity, and increased insulin secretion. Evidence is mounting for the use of bariatric surgery to treat type 2 diabetes mellitus in patients whose body mass index (BMI) is 35 kg/m2 or higher. In obese patients who also have type 2 diabetes, bariatric surgery sends it into remission (defined as normoglycemic control without the need for diabetic medications) in more than three-fourths of cases, with higher rates with the Roux-en-Y gastric bypass procedure than with the laparoscopic adjustab Continue reading >>

Bariatric Surgery - Mayo Clinic

Bariatric Surgery - Mayo Clinic

Gastric bypass and other weight-loss surgeries make changes to your digestive system to help you lose weight by limiting how much you can eat or by reducing the absorption of nutrients, or both. Gastric bypass and other weight-loss surgeries are done when diet and exercise haven't worked or when you have serious health problems because of your weight. There are many types of weight-loss surgery, known collectively as bariatric surgery. Gastric bypass is one of the most common types of bariatric surgery in the United States. Many surgeons prefer gastric bypass surgery because it generally has fewer complications than do other weight-loss surgeries. Still, all forms of weight-loss surgery, including gastric bypass, are major procedures that can pose serious risks and side effects. Also, you must make permanent healthy changes to your diet and get regular exercise to help ensure the long-term success of bariatric surgery. Gastric bypass and other weight-loss surgeries are typically done only after you've tried to lose weight by improving your diet and exercise habits. In general, gastric bypass and other weight-loss surgeries could be an option for you if: Your body mass index (BMI) is 40 or higher (extreme obesity). Your BMI is 35 to 39.9 (obesity), and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea. In some cases, you may qualify for certain types of weight-loss surgery if your BMI is 30 to 34 and you have serious weight-related health problems. But gastric bypass isn't for everyone who is severely overweight. You may need to meet certain medical guidelines to qualify for weight-loss surgery. You likely will have an extensive screening process to see if you qualify. You must also be willing to make pe Continue reading >>

Benefits And Risks Of Weight-loss Surgery For Diabetes

Benefits And Risks Of Weight-loss Surgery For Diabetes

Benefits and Risks Of Weight-Loss Surgery For Diabetes A growing number of persistently overweight, or obese individuals are undergoing weight-loss surgery to shed pounds, and better manage their diabetes. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), weight-loss surgery improves type 2 diabetes in almost 90 percent of patients by lowering blood sugar levels, reducing the dosage and types of medication needed, and alleviating diabetes-related health problems. Despite the amazing potential health benefits, weight-loss surgery is an option that must be carefully considered, and here are three reasons why: Its Not Easy Weight Loss. Weight-loss surgery is an effective, permanent weight solution, but only if necessary lifestyle changes - such as making daily wise food choices - are maintained. Because making the most of weight-loss surgery demands a certain level of commitment and diligence, patients typically undergo psychological assessments, nutritional, and lifestyle counseling prior to their procedures. Success requires the hard work of changing long-held attitudes and behaviors related to food. Its Not Considered A Type 2 Cure. Though many patients experience significant improvements in blood sugar levels following weight-loss surgery, and may eventually have their glucose levels return to normal, it seems that endocrinologists do not consider the surgery a type 2 diabetes cure. They instead consider it a remission of symptoms that will return if healthy lifestyle guidelines are disregarded, and may return even if guidelines are followed. All Surgery Carries Risk. The ASMBS points out the risks involved with weight-loss surgery are significantly less than the long term risks of continued high blood sugar. However, surgical risk needs t Continue reading >>

Gastric Bypass Surgery Helps Diabetes But Does Not Cure It

Gastric Bypass Surgery Helps Diabetes But Does Not Cure It

Gastric bypass surgery for patients with type two diabetes, in most cases, is either remitted or relapses within five years, researchers from the Group Health Research Institute reported in the journal Obesity Surgery. The authors explained that after gastric bypass surgery, diabetes symptoms may disappear for some patients - in many cases before they lose a lot of weight. Does this mean, therefore, that gastric bypass surgery is a "cure" for diabetes? Not necessarily, they wrote, after gathering and analyzing data from the largest community-based study that looked at the long-term outcomes after bariatric surgery among diabetes patients. For two thirds of the participants in the study, their diabetes initially disappeared after gastric surgery - however, symptoms returned within five years among one third of them. They added the proportion of patients whose diabetes never went away after surgery, and found that 56% had no long-lasting diabetes remission. When diabetes did go away, it stayed away for several years - an important benefit. Experts know that bariatric surgery (weight loss surgery) is much more effective in reducing heart disease and stroke risk than medications, researchers from the Cleveland Clinic recently explained. They reported their findings in the journal Heart (October 2012 issue). Their study involved very obese patients, including those with and without diabetes. Who receives the most benefit from gastric surgery? Lead researcher, David E. Arterburn, MD, MPH, explained that those with less severe diabetes symptoms tended to benefit the most from gastric surgery - they were the ones most likely to experience remission after the operation, and for longer. Dr. Arterburn said: "Gastric surgery isn't for everyone. But this evidence suggests that, once Continue reading >>

Bariatric Surgery For Type 2 Diabetes Reversal: The Risks

Bariatric Surgery For Type 2 Diabetes Reversal: The Risks

Bariatric Surgery for Type 2 Diabetes Reversal: The Risks Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel Corresponding author: Andrei Keidar, [email protected] . Author information Copyright and License information Disclaimer Copyright 2011 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details. This article has been cited by other articles in PMC. The twin epidemics of obesity and type 2 diabetes are on the rise. From 1986 to 2000, the prevalence of BMI 30 kg/m2 doubled, whereas that of BMI >40 kg/m2 quadrupled, and even extreme obesity of BMI 50 kg/m2 increased fivefold ( 1 ). Of particular concern is the alarming increasing prevalence of obesity among children, suggesting that the epidemic will worsen ( 2 ). The impact of obesity on longevity has been well documented. In the world, over 2.5 million deaths annually can be attributed to obesity; in the U.S. alone over 400,000 deaths attributable to obesity occur per yearsecond only to those attributable to cigarette smoking. There is a direct relationship between increasing BMI and relative risk of dying prematurely, as evidenced in the Nurses Health Study with a 100% increase in relative risk as BMI increased from 19 to 32 kg/m2. Annual risk of death can be as high as 40-fold that of an age- and sex-matched nonobese cohort ( 3 , 4 ). The Framingham data revealed that for each pound gained between ages 30 and 42 years there was a 1% increased mortality within 26 years, and for each pound gained thereafter there was a 2% increased mortality. Only one in seven obese individuals will reach the U.S. life expectancy of 76.9 years. In the mor Continue reading >>

Diabetes Cure - Consumer Guide To Bariatric Surgery

Diabetes Cure - Consumer Guide To Bariatric Surgery

By Denise Mann ; reviewed by Christine Ren Fielding, MD, FACS Weight loss surgery may cure diabetes, suggest widespread media reports. But can surgery really reverse this disease? To find out what is known and what we still need to learn about the relationship between diabetes, obesity and weight loss surgery , Consumer Guide to Bariatric Surgery asked members of its advisory board to weigh in on the research. Diabetes and obesity are intimately connected. Almost 90 percent of people newly diagnosed with diabetes are overweight or obese, according to the American Diabetes Association . "The relationship between diabetes and obesity should be screamed from the rooftops," says Christine Ren Fielding, MD, FACS, an associate professor of surgery and the founder and director of the New York University Program for Surgical Weight Loss. "Many people don't understand just how closely diabetes and obesity are related," she says. An obese person has double the risk of developing diabetes, and a severely obese person has ten times the risk. Exactly how the two conditions are related is not fully understood, but the guiding theory is that too much abdominal or belly fat is associated with a defect in the body's response to insulin. Type 2 diabetes is the form of the disease most closely linked to obesity. Approximately 90 percent of all diabetics in the United States are type 2 diabetics. In this form of diabetes, the body does not produce enough of the hormone insulin, or the cells in the body do not use insulin properly. Insulin is necessary for the body to be able to use glucose or blood sugar for energy. As a result, glucose builds up in the blood, where it can wreak havoc, instead of going into cells. Complications of diabetes include heart disease, blindness, nerve damage an 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 >>

Is Weight Loss Surgery The Answer For Diabetes?

Is Weight Loss Surgery The Answer For Diabetes?

With commentary by Anita P. Courcoulas MD, MPH, FACS, professor of surgery and director of minimally invasive bariatric & general surgery at the University of Pittsburgh Medical Center Is weight-loss surgery better than nutrition and physical activity alone for reversing type 2 diabetes? That controversial question has occupied researchers, doctors, insurers and people with diabetes for more than a decade. Now, a small yet well-designed study seems to have the answer: Surgery. University of Pittsburgh researchers randomly assigned 61 obese women and men with type 2 diabetes to receive gastric bypass surgery, an adjustable gastric band or an intensive lifestyle change program. Study volunteers were tracked closely for three years, as scientists monitored their weight, fasting blood sugar, A1c levels (a test of long-term blood sugar control) and use of insulin and other diabetes medications. The results: More weight (and fat) lost: Gastric bypass recipients lost an average of 25% of their body weight (and nearly 11% of their body fat), gastric band wearers dropped 15% of their weight (and 5.6% of their body fat) and lifestyle group members lost 5.7% of their weight and 3% of their body fat. People in the gastric bypass also saw their waist size shrink the most, an indicator that they’d lost the most visceral fat – the kind that packs around internal organs and contributes to blood sugar processing problems. Lower blood sugar: People in the gastric bypass group saw fasting blood sugar drop 66 mg/dL and their A1c levels fall 1.4%. In comparison, gastric band recipients got a 35-point reduction in fasting blood sugar and a 0.8% reduction in A1c levels. For the lifestyle-only group, fasting blood sugar fell an average of about 28 mg/dL but A1c levels rose slightly. Less d Continue reading >>

Diabetic Ketoacidosis A Risk After Bariatric Surgery

Diabetic Ketoacidosis A Risk After Bariatric Surgery

Diabetic Ketoacidosis a Risk after Bariatric Surgery Researchers at the Cleveland Clinic have found that while bariatric surgery is considered a safe and effective treatment for obesity and its comorbidities, diabetic ketoacidosis (DKA) can occur in diabetic patients following weight-loss procedures. The findings were recently published in Diabetes Care. The investigators, led by Ali Aminian, MD, point out that the characteristics of DKA following bariatric surgery have not been explored, so they analyzed 12 patients who from January 2005 to December 2015 developed DKA within 90 days of surgery. Eight of these patients had type 1 diabetes (T1D), while four had type 2 diabetes (T2D), and three of them had a past history of DKA. Six patients had undergone laparoscopic Roux-en-Y gastric bypass, four underwent laparoscopic sleeve gastrectomy, and two had laparoscopic adjustable gastric banding. One patient even developed two episodes of postoperative DKA. The authors also point out that eight of these patients had inadequate insulin therapy or were non-compliant, and three of these patients developed DKA before they were even discharged from the hospital following their weight-loss procedures, which they write could be explained by the combination of undertreatment with insulin and surgical stress. The median time between surgery and DKA was 12 days. Infection was a precipitating factor for the development of DKA in four (33%) patients, the authors write. Poor oral intake (for several days) could be a contributing factor in three (25%) patients. Aminian and his team note that this is the largest case series of this kind to date. Based on what they observed in this study, as well as the literature, they conclude that its not uncommon for patients with poorly controlled T1D Continue reading >>

Bariatric Surgery: American Diabetes Association

Bariatric Surgery: American Diabetes Association

Bariatric surgery (Gastric Bypass or Laparoscopic Gastric Banding) is sometimes considered for adults with a body mass index (BMI) above 35 and type 2 diabetes, especially if the diabetes is difficult to control with lifestyle changes and medicines. Although small trials have shown benefits to blood glucose control in patients with type 2 diabetes and high BMI, there isn't enough evidence for people with BMIs lower than 35. There are two main types of bariatric surgery: Gastric bypass surgery: shrinks the stomach (from the size of a fist to that of a thumb) and shortens the path food takes through the small intestine. This limits the number of calories absorbed. This change is permanent. Laparoscopic Gastric Banding also known as Lap-banding: a belt is wrapped around the stomach. This belt cinches the stomach so that it will feel full with less food. This change can be adjusted or reversed if needed. Because bariatric surgery is not regarded as a cure, it is recommended that individuals who have undergone a bariatric procedure continue to have the regular screenings that are recommended for people with diabetes, whether or not their glucose levels have normalized. In addition, they need careful ongoing assessments of blood glucose control conducted by their health care provider, as those with normal blood glucose levels after surgery are at risk for a return of hyperglycemia. Continue reading >>

Unveiling The “magic” Of Diabetes Remission After Weight-loss Surgery

Unveiling The “magic” Of Diabetes Remission After Weight-loss Surgery

An extraordinary thing happens to some patients with type 2 diabetes who undergo weight-loss surgery: Within days of the procedure, they improve their insulin production and need fewer or no diabetes medications. Although it’s well established that losing weight, especially around the waistline, improves pancreas function and insulin sensitivity, it generally takes 6 months to a year after bariatric surgery before a patient sheds a substantial number of pounds. Bruce M. Wolfe, MD, professor of surgery at Oregon Health and Science University School of Medicine, recalled one “remarkable” case in which a patient who required 400 daily units of insulin prior to gastric bypass surgery needed none on the day she was discharged from the hospital. 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 >>

How Does Gastric Bypass Surgery Cure Type 2 Diabetes?

How Does Gastric Bypass Surgery Cure Type 2 Diabetes?

Gastric bypass surgery often improves the symptoms of type 2 diabetes, even before patients start to lose weight. Why? “What we found is that the secret for the cure of diabetes after gastric bypass lies in the intestine,” said Dr. Nicholas Stylopoulos, principal investigator at the Division of Endocrinology at Children's Hospital Boston and Boston Medical School, in an interview with Healthline. “The key message is that after gastric bypass the intestine becomes the most important tissue for glucose use and this decreases blood sugar levels.” His research was published last week in the journal Science. Doctors are hopeful they can find a way to mimic the processes that lead to improvements for type 2 diabetics after gastric bypass without actually doing the surgery. Small Intestine to the Rescue Here's how it works: After gastric bypass, which is a common weight loss solution for the severely obese, the small intestine spontaneously begins to produce a molecule called GLUT-1 that helps the body use glucose. “The quite amazing thing is that this is not present normally in the small intestine of adults, but only in the fetus,” said Dr. Erini Nestoridi, a research fellow in Stylopoulos' lab, in an interview with Healthline. “This happens most likely because the intestine has to work harder to do its job, for example to absorb the nutrients or move the food further down. Also, it may be that the mechanical stress of 'dumping' the food directly to the intestine, since the stomach is bypassed, contributes to these changes.” Although weight loss and improved diabetes symptoms go hand in hand, previous research has shown that gastric bypass surgery helps resolve the disease even before weight loss occurs. According to the U.S. Centers for Disease Control and Pr Continue reading >>

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