Bariatric Surgery Benefits Diabetic Patients

Dibetes has become epidemic . there are about 170 million people worldwide in year 2000 & Estimated to be more than 366 million by 2030. Type 2 diabetes mellitus is a complex disease characterized by insulin resistance and progressive failure of pancreatic beta cells, resulting in high blood sugar.

Obesity, a potent risk factor for type 2 diabetes, contributes to its development by inducing insulin resistance and inflammation, which in turn impair glucose regulation. Fat deposits in the abdomen, muscles, and liver contribute to increase in circulating free fatty acids and fat cells-derived cytokines that mediate insulin resistance and inflammatory pathways.

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 (means blood sugar control without the need for diabetic medications) in more than three-fourths of cases, with higher rates with the Gastric bypass procedure than with the laparoscopic adjustable gastric banding procedure.

There are main two factors which play role in this benefit after weight loss ( bariatric surgery))

weight loss
but also to better insulin sensitivity and to alterations in levels of hormones secreted by the gut that increase insulin secretion.

The current medical approach to type 2 diabetes includes advising the patient to lose weight through lifestyle modification, and prescribing drugs that restore glycemic control by reducing insulin resistance (biguanides, glitazones) and improving insulin secretion (incretin mimetics and analogues and sulfonylureas).

However, several factors make type-2 diabetes challenging to treat in obese people. Patients who lose weight via behavioral changes and weight-loss drugs tend to gain the weight back. Anti diabetic drugs pose the risk of hypoglycemia. Moreover, although many new classes of drugs have been developed to treat type 2 diabetes, most patients fail to achieve the American Diabetes Association goal for glycemic control, ie, a hemoglobin A1c level lower than 7%.

BARIATRIC PROCEDURES AND THEIR EFFECT ON DIABETES CONTROL

After bariatric surgery, patients lose more weight than with traditional weight-loss methods—up to 25% of their total body weight. Furthermore, of those with type 2 diabetes, 87% achieve at least better glucose control and need fewer anti diabetic medications and an average of 78% achieve normal glycemic control without taking any anti diabetic medications at all. But not all bariatric procedures have the same effect on weight and diabetes: certain procedures have a greater effect.

The two major types are classified as gastric restrictive procedures and intestinal bypass procedures. The classification was initially based on the presumed mechanism of weight loss.

Gastric restrictive procedures (laparoscopic adjustable gastric banding, sleeve gastrectomy, ) limit gastric volume and, hence, restrict the intake of calories by inducing satiety. Afterward, patients lose approximately 10% to 20% of their total body weight.

Intestinal bypass procedures (Roux-en-Y gastric bypass, biliopancreatic diversion) also restrict caloric intake, the way gastric banding do. But because the small intestine is shortened, they have an added component of malabsorption of fat and nutrients. Afterward, more patients experience remission of type 2 diabetes (82%–99%) than after gastric restrictive operations, even patients with longer duration of disease, including those treated with insulin DIABETES