Surgery Can Resolve Diabetes
Emerging data suggest that bariatric surgery results in substantial improvements in glycemia, blood pressure, and cholesterol; weight loss is durable; survival may be improved; and surgical risks are low.
The Great Debate: Medicine or Surgery: Mechanisms of Weight Loss after Bariatric Surgery
Mechanisms of Weight Loss after Bariatric Surgery
The effectiveness of bariatric surgical procedures in improving type 2 diabetes was originally ascribed to substantial dietary changes and weight loss. More recently, several lines of evidence suggest that bariatric surgical procedures, especially the Roux-en-Y gastric bypass (RYGB), have glycemic effects in part independent of weight loss. Such evidence includes 1) animal data showing that diversion of enteral flow from the duodenum, which occurs in RYGB, improves type 2 diabetes even in nonobese animals; 2) patients receiving RYGB experience greater early improvements in glycemia compared with patients receiving laparoscopic adjustable gastric band (LAGB) on the same postoperative diet; 3) in contrast with LABG, very early improvements in insulin sensitivity and β-cell function have been demonstrated;[15,16] 4) a small group of patients have recently been identified who have developed late-onset hyperinsulinemic hypoglycemia after RYGB, usually manifesting after maximal weight loss results have been realized,[17,18] implicating a potential chronic stimulatory effect on the β-cell; and 5) altered nutrient delivery through the gastric compared with gastric bypass route alters glucose tolerance, insulin dynamics, and other metabolic measures.[19,20]