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OLD TREATMENTS FOR WEIGHT LOSS ARE NEW FOR DIABETES!

Type 2 Diabetes accounts for 22% of US adults and 35% of Mexican population and the type 2 DM is responsible for 95% of all cases of Diabetes.

60% of obese patients have Metabolic Syndrome (T2 Diabetes, HBP 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 increase interest for surgical procedures that completely resolve or improve Type II Diabetes and Metabolic Syndrome world wide and the Bariatric Surgeons -Weight Loss Surgeons- are asked about their experience in this matter for the better understanding and treatment of this disease.

We know now after years of Gastrointestinal Weight Loss procedures that there are 2 main effects achieved: one is over the weight, the Bariatric Effect, and the second is over the metabolic syndrome, the Metabolic Effect.

We all know that while you are losing weight your blood sugar improves. Except with the Gastric Band, the other gastrointestinal weight loss procedures like Gastric Bypass, Duodenal Bypass, Gastric Sleeve, Duodenal Switch or Bilio-Pancreatic Diversion, the blood sugar improves long before is a significant loss of weight and many times the sugar blood improvement is just days after the surgery.

When talking about Total Resolution or Remission of type 2 Diabetes, meaning normal blood sugar after 18 months, the Gastric Band does it 50% of the cases, the Gastric Bypass 70%, the Gastric Sleeve 85% and the Duodenal Exclusion Procedures with or without Sleeve 92%.

Patients that need insulin are more resistant to cure the Type2 Diabetes and the length of been Diabetic also plays an important roll in the total resolution of the Diabetes but still is a great improvement with the surgeries.

There are different explanations on this metabolic effect and most are related to the nature of the malabsortive procedures that involves the exclusion of the food passing through out the duodenum with the exception of the Gastric Sleeve where the gastrointestinal tract has no changes but 80% of the stomach is taken out.

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 Incretins secretion have 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.

The individuals with a BMI 35 or less we observed with the malabsortive procedures lower weight loss effect but the metabolic effect remains the same as seen in bigger patients that means that this procedures are very effective for treating Diabetes.
The obese patients and the Type 2 Diabetic patients have to 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 any of them.

Dr. Arturo Rodriguez

     

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