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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.

 
 
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