Advertisement
Gastric Bypass Surgery for Mild Obesity in Diabetics

Gastric Bypass Surgery for Mild Obesity in Diabetics

In 2003, a study of more than 1,000 patients who underwent gastric bypass found that one-third of those with diabetes at baseline had normal blood sugars after their surgery and didn’t need medication when they were discharged from their surgical hospitalization. This finding sparked further exploration into the effects of gastric bypass surgery on weight-independent, antidiabetes mechanisms. Testing a New Population In Diabetes Care, my colleagues and I had a study published that explored the use of Roux-en-Y gastric bypass (RYGB) as a primary modality to treat type 2 diabetes in patients for whom weight loss was not the primary objective. When we began the study, clinical observations had suggested that diabetes remits in about 80% of patients who undergo gastric bypass. What we didn’t know was the durability of that effect or what the outcomes would be in patients who weren’t severely obese. In our analysis, we selected 66 consecutive patients with type 2 diabetes who were mildly obese (BMI between 30 kg/m2 and 35 kg/m2) to undergo RYGB. These patients were prospectively studied for up to 6 years. At baseline, they had an average A1C of 9.7% despite being on insulin or at least two diabetes medications. At 6 months after RYGB, the average A1C level decreased to 6.5% and continued to decrease to 6.1% at 6 years, with 100% follow-up in this cohort. At the latest follow-up, 88% of patients had achieved diabetes remission, which was defined as having an A1C of 6.5% or less and being off all diabetes medications. We also found that â-cells were nearly five times more sensitive to blood sugar, on...

Comparing Efficacy of Weight-Loss Procedures

When compared with laparoscopic bypass procedures, Roux-en-Y gastric bypass (RYGB) surgery appears to have similar rates of overall complications and lower rates of reoperations when these operations are performed in high-volume centers by expert surgeons, according to a University of California, San Francisco study. Excess weight loss (36% vs 64%), resolution of diabetes (50% vs 76%), and quality-of-life measures were better in the RYGB group in the analysis, conferring a better risk-benefit profile than laparoscopic bypass procedures. [xyz_lbx_custom_shortcode id=3] [xyz_lbx_custom_shortcode...

Post-Op Management of Bariatric Surgery

Bariatric surgery has gained wide acceptance as an effective treatment for morbid obesity, especially among those suffering with type 2 diabetes. In 2009, it’s estimated that 200,000 bariatric procedures were performed at a cost of about $5 billion, and these figures are likely to increase as the obesity epidemic continues to grow. Bariatric surgery, however, does not guarantee success, and patients require postoperative care. Approximately 20% of patients either fail to lose weight or regain weight post-surgery. To reduce this likelihood and to ensure that comorbid conditions are managed appropriately, all patients should receive careful medical follow-up after their surgery. In the November 8, 2010 Journal of Clinical Endocrinology & Metabolism, the Endocrine Society published a clinical practice guideline on the nutritional and endocrine management of adults after bariatric surgery, including those with diabetes. The evidence-based recommendations (available online at http://jcem.endojournals.org) focus on the immediate postoperative period and long-term management to prevent complications, weight regain, and management of obesity-associated comorbidities. Key Recommendations The guidelines recommend that all patients undergo active nutritional patient education and clinical management to prevent and identify deficiencies after bariatric surgery. The management of nutritional deficiencies is especially important for patients undergoing malabsorptive procedures (eg, Roux-en-Y gastric bypass). To be most successful during and after surgery, a proficient surgical program—preferably one that has been accredited by a national certifying group—and an integrated medical support team that offers proven dietary and behavioral strategies should be available to patients postoperatively and during long-term follow-up. Postoperative treatment of weight regain should include diet instruction, increased physical activity, behavior modification, and possibly pharmacologic therapy. An average daily protein intake of 60 g...
[ HIDE/SHOW ]