Friday, November 20, 2009

Gastric Bypass And Diabetes

Obesity is a very common disease. Diabetes is also a very common disease. It comes as no surprise that these two diseases occur together with a high frequency. While there is no clear causal link between obesity and diabetes, there is a fairly high correlation. If you are obese, you are at much higher risk of developing diabetes, and vice versa.

The link between two diseases raises the question: is gastric bypass surgery an option for diabetic obese patients? The question is intriguing. Diabetes is a disease in which the body has either a total lack of insulin, or decreased insulin production paired with decreased sensitivity to insulin in end organ tissues. The result of this is that blood sugar levels remain elevated, a state termed 'hyperglycemia.' Diabetes can lead to many debilitating problems, such as blindness, kidney problems, and even foot amputations. Diabetes also increases your risk for strokes and heart attacks. With such harmful effects a possibility, the question of whether gastric bypass surgery can be effective for diabetic patients is a valid one.

To address this question, the American Diabetes Association, or ADA, released in 2009 a Standard of Care statement addressing bariatric surgery specifically:
Gastric reduction surgery, either gastric banding or procedures that involve bypassing or transposing sections of the small intestine, when part of a comprehensive team approach, can be an effective weight loss treatment for severe obesity, and national guidelines support its consideration for people with type 2 diabetes who have BMI at or exceeding 35 kg/m2. Bariatric surgery has been shown to lead to near or complete normalization of glycemia in 55–95% of patients with type 2 diabetes, depending on the surgical procedure. A meta-analysis of studies of bariatric surgery reported that 78% of individuals with type 2 diabetes had complete “resolution” of diabetes (normalization of blood glucose levels in the absence of medications), and that the resolution rates were sustained in studies that had follow-up exceeding 2 years (96). Resolution rates are lowest with procedures that only constrict the stomach and higher with those that bypass portions of the small intestine. Additionally, there is increasing evidence that intestinal bypass procedures may have glycemic effects that are independent of, and additive to, their effects on weight.

Given these results and this view from the ADA, if you are diabetic, obese, and living in the greater Houston area, you should consider asking your physician about gastric bypass surgery, or contacting a bariatric surgeon yourself. Ultimately, the person in charge of your obesity and your diabetes is *you*, so take charge today and make a difference in your life!

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