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What Is Bariatric Surgery For Diabetes?

The Role Of Bariatric Surgery To Treat Diabetes: Current Challenges And Perspectives

The Role Of Bariatric Surgery To Treat Diabetes: Current Challenges And Perspectives

The role of bariatric surgery to treat diabetes: current challenges and perspectives 1 Carel W. le Roux ,2,3 and Alexander Kokkinos 1 1First Department of Propaedeutic Internal Medicine, Diabetes Centre, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece 1First Department of Propaedeutic Internal Medicine, Diabetes Centre, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece 2Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland 3Investigative Science, Imperial College London, London, UK 1First Department of Propaedeutic Internal Medicine, Diabetes Centre, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece 1First Department of Propaedeutic Internal Medicine, Diabetes Centre, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece 2Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland 3Investigative Science, Imperial College London, London, UK Chrysi Koliaki, Email: [email protected] . Received 2017 May 27; Accepted 2017 Aug 6. Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated. Bariatric surgery is emerging as a powerful weapon against severe Continue reading >>

Obesity Action Coalition Dear Doctor Can Bariatric Surgery Treat Type 2 Diabetes?

Obesity Action Coalition Dear Doctor Can Bariatric Surgery Treat Type 2 Diabetes?

Dear Doctor -Can Bariatric Surgery Treat Type 2 Diabetes? Answer provided by Lloyd Stegemann, MD, FASMBS To view a PDF version of this article, click here . Diabetes is a devastating problem worldwide. It has been estimated that as much as 8.3 percent of the worlds population has diabetes and this number is on the rise. As your weight goes up, so does your risk of developing type 2 diabetes (T2D). In fact, almost 25 percent of individuals who are affected by severe obesity (body mass index greater than 35) will carry a diagnosis of T2D. Uncontrolled diabetes leads to a host of long-term problems including heart attacks, strokes, kidney failure, blindness and the need for amputations. For many years, bariatric surgeons have known that bariatric surgery has a profound effect on T2D. It is not uncommon for our T2D patients to come off of all of their diabetic medications after bariatric surgery. Many primary care physicians (PCP), however, have been reluctant to advise bariatric surgery as the first line of treatment for their patients affected by severe obesity with T2D because of the lack of quality studies comparing the effectiveness of medical therapy versus surgical therapy for the treatment of T2D. Two recent studies that appeared in the New England Journal of Medicine were designed to help answer this question. In the first study, known as the STAMPEDE trial, 150 poorly controlled diabetic patients were divided randomly and equally into three groups. All of the patients in the study received intensive medical therapy including lifestyle counseling, weight management, frequent blood sugar monitoring, and diabetic medications. Fifty of the patients then continued with this intense medical therapy, 50 underwent a roux-en-y gastric bypass surgery, and the other 50 pati 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 >>

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 >>

Curing Diabetes: The Only Confirmed (pseudo) Cure

Curing Diabetes: The Only Confirmed (pseudo) Cure

Curing diabetes has been a goal of physicians and diabetic patients since it was first discovered by the Ancient Greeks in the 1st century (1). Almost 2,000 years later, it seems that we have finally learned how to cure diabetes, or at least provide a “pseudo-cure” that puts diabetes into potentially permanent remission: bariatric surgery. Review and click the sections below to learn more about the only known cure for diabetes. Continue reading >>

The Strange Side Effect Of Gastric Bypass That Helps Diabetics

The Strange Side Effect Of Gastric Bypass That Helps Diabetics

Gastric bypass seems to help diabetic patients by changing the way their body regulates gut hormones . This may be because theres no more stomach cavity, or perhaps because a small section of the intestines where these hormones might be stimulated is removed no one is quite sure . But we do know that around two thirds of patients who get gastric bypass dont require any medication to treat their diabetes, and they stay that way for years ( follow-up studies have only gone out five years so far). The weight loss itself also helps, since shedding body fat improves diabetes generally, but patients on traditional medication and weight loss interventions dont see nearly the same improvement. In fact, many of them are in exactly the same position at the five-year mark as they were on day one, while their surgically-enhanced counterparts have often put their diabetes into remission. Some other bariatric surgeries are just as good for diabetics As we said earlier, gastric bypass is only the best-known of the bariatric surgeries. Theres also an adjustable gastric band, which is exactly what it sounds like: a band that creates a smaller stomach pouch over time as its tightened. Its not the most effective method for either weight loss or diabetes improvement, but it is (relatively) easy and fast, and has the lowest rate of surgical complications. Another method is the sleeve gastrectomy, which doesnt so much put a sleeve on the stomach as it does make the stomach look like a sleeve. By removing part of the organ, surgeons can make it smaller and more tubular. This method seems to be just as effective as full gastric bypass in terms of both weight loss and diabetes remissionpeople lose about 50 percent of their body mass and a majority of patients see improvement in their gut hormo 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 >>

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 >>

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 >>

Weight Loss Surgery For Type 2 Diabetes

Weight Loss Surgery For Type 2 Diabetes

For many years, a variety of obesity surgery procedures applied to the stomach or intestine have been used as a method of losing weight, and losing weight can help people manage their Type 2 diabetes. More recently, medical research has shown that obesity surgery can also directly affect how the body uses insulin. In addition to the benefit of directly losing weight and improving blood sugar levels, this surgery itself assists people in managing their Type 2 diabetes. It can: change how the hormones in your gut work, which in turn affects how your body makes insulin increase the amount of bile acids that your body makes – these make your body cells more sensitive to insulin improve the way the cells use insulin, leading to lower blood sugar levels. What are the different versions of Type 2 diabetes surgery? There are various forms of obesity surgery, also known as bariatric surgery, that may be offered. Surgical options include removal of part of the stomach to reduce stomach size and consequently restrict appetite and food intake, or a surgical re-route of the digestive system to bypass the stomach. Both treatments assist people in reducing their food intake due to requiring less food to feel full, but also beneficially affect how your body uses insulin. You can discuss surgery with your diabetes healthcare team, who will be able to give you further information. Who can have surgery for diabetes? Until now, surgery of this type hasn’t been fully recognised as a standard treatment for Type 2 diabetes. NICE obesity guidelines recommend surgery for weight loss for people who meet certain strict criteria, including those newly diagnosed with Type 2 diabetes. However, in practice surgery is mostly offered only for a restricted group of people who have already attempted 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 >>

Can Bariatric Surgery Cure Type 2 Diabetes?

Can Bariatric Surgery Cure Type 2 Diabetes?

Can Bariatric Surgery Cure Type 2 Diabetes? More and more studies claim that the answer may be "yes"; in many cases, bariatric surgery is an effective cure for those suffering from type 2 diabetes. To be clear, diabetes is not well understood and medical science cannot claim a permanent cure. The goal is to put diabetes in remission. Remission means a return to normal blood sugar levels and no need for diabetes medications. With glucose at normal levels, the progression of diabetic complications is halted, thus giving the body a chance to repair the damage. In other words, remission means that you are presently "cured" and will remain so, unless the factors causing the disease return to a degree sufficient to cause a relapse. So, the correct question is, does bariatric surgery cause type 2 diabetes to go into remission? And, in many cases, the answer is a resounding yes. How does bariatric surgery cure Type 2 diabetes? We know that bariatric surgery puts type 2 diabetes into remission; what we dont know is how it does it. It's clear that healthy weight loss plays a significant role in reducing blood sugar levels in Type 2 diabetics, and bariatric surgery has been proven to be the most effective way for obese patients to lose significant body weight. But, there are additional factors at work. Many see an instant reversal of their diabetes immediately after gastric bypass surgery or gastric sleeve surgery before they lose any weight. This is what science doesn't fully understand. One theory suggests that bypassing or removing part of the stomach immediately impacts the way glucose is processed in the digestive system. Another claims that by shunting food directly to the lower intestine, a substance called glucagon-like peptide 1 (GLP-1) is stimulated, which can increase Continue reading >>

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 >>

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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