|
Bariatric Surgery and Diabetes
Although the available data on the prevalence of type 2 Diabetes
in the Arab Countries is still limited, the condition appears to
be a significant problem. According to the results of a national
diabetes survey, conducted in 2000 by the Ministry of Health and
the World Health Organisation (WHO), almost a quarter, ( one in
four) of the population in the Arab World has diabetes in one form
or another. If the current trends continue in the next 25 years,
diabetes will affect as many as half the people in the country.
80% of type II diabetes is related to obesity
Diabetes is marked by high levels of sugar (glucose) in the blood and occurs when the body does not respond correctly to insulin, a hormone released by the pancreas. An obese person has double the risk of developing diabetes, and a severely obese person is at a tenfold increased risk.
The risk of developing diabetes also increases with age, family history and obesity localized more in the abdomen (central obesity). Consumption of fatty and high-carbohydrate foods leads not only to obesity, but also to a higher amount of fatty acids in the blood and a buildup of lipids in the liver and skeletal muscles, causing resistance to insulin and consequently diabetes.
Can we cure diabetes through Bariatric Surgery?
The Surgical procedures that have been used so far, purely with
an intention to reverse Obesity, have found a new indication- the
CURE of Diabetes. Therefore, it's only reasonable that they could
be recommended purely for this indication, especially for those
with poorly controlled diabetes, even if weight loss is not the
objective.
It is known that around 20% of severely obese patients develop diabetes.
Bariatric surgery has been shown to improve or resolve type 2 Diabetes.
Immediately after surgery, blood sugar levels improve and diabetic
medications can be stopped. This happens even before significant
weight loss. Recent studies show that this is due to the change
in fat tissues leading to improvement of insulin resistance. Changes
in gut hormones which control metabolism have also been shown to
change, indicating a hormonal mechanism for weight loss.
The most commonly performed type of bariatric surgery, Roux- EN-Y
gastric bypass, improves diabetes not only through rapid weight-loss,
but also by excluding (bypassing) a portion of the small intestine
from the flow of nutrients. This means that gastric bypass surgery
improves diabetes even before weight is lost.
The production of various gut hormones is changed following gastric
bypass, leading to improvement of insulin secretion. Almost 90 percent
of obese patients who undergo Roux- EN-Y gastric bypass are free
from diabetes one year after surgery. These results are typically
persistent for the rest of life, as long as a healthy body weight
is maintained. Patients who have a milder form of diabetes (controlled
with diet) for less than five years, and who achieve greater weight-loss
after surgery, are more likely to also achieve complete resolution
of diabetes. Weight-loss following gastric bypass in obese non-diabetic
patients decreases their likelihood of developing diabetes by 60
percent over four years.
THE EARLIER THE SURGERY, THE BETTER THE RESULTS
The longer a patient has diabetes, the greater the likelihood
of irreversible loss of insulin production. A key finding of all
studies is that the less time one suffers from diabetes; the more
likely he or she will have complete remission of diabetes following
surgery.
|
 |
