Lisa Kohler, MD - AkronCantonMDNews

Since that time, over 20 studies have been conducted, including
a recent medical analysis that shows a significant improvement
and/or remission of Type 2 diabetes that is quite durable. In
their meta-analysis, Buchwald et al calculated that diabetes improved
or resolved in 86% of bariatric surgery patients, although
diabetic outcomes varied according to operative procedure.
Diabetes resolved completely in 84% of gastric bypass patients.
Biliopancreatic diversion and gastric bypass patients had the most
improvements in hyperlipidemia postoperatively (99% and 97%
resolution, respectively). 9
The improvement appears to be dependent on a number of factors,
including type of procedure. Gastric banding generally results
in a remission rate of approximately 40-50%. For gastric bypass
the resolution rate is approximately 83% and for biliopancreatic
diversion, the resolution rate is 80-100%. A mechanism of resolution
appears to be related to weight loss and perhaps to other
factors. The fact that approximately 30% of patients who have
gastric bypass have an immediate remission (prior to discharge
from the hospital) suggests that factors other than weight loss may
play a very important role.
Recent work by leading investigators suggests that many gut
hormones positively affect insulin resistance and insulin production
including GLP1, GIP, PYY, and Ghrelin. Investigators have
suggested that the bypass of the stomach and duodenum may be
a key factor in altering the secretions of
these hormones.
The durability of this effect has been
shown to be sustained up to and beyond 10
years. A recent study, the Swedish Obesity
Subject Study, compared approximately
2,000 patients who had bariatric procedures
with a matched cohort who did not
have surgery and found the surgical group
had dramatically reduced incidence of
type 2 diabetes and a high remission rate
that was sustained out to 10 years. 10 Other
studies support this durable effect on type
2 diabetes. A 2003 study published in the
Annals of Surgery found that diabetes patients
who received laparoscopic gastric bypass
surgery experienced a mean weight loss of
60%, resulting in resolution of their diabetes
in 83% of cases. 2 The remaining 17% of
patients involved in the study saw marked
improvement in their type 2 diabetes following
surgery. The group most likely to
see complete resolution of their diabetes
included patients who had diabetes for fewer
than five years, were able to control it with
diet alone, and saw the greatest weight loss
after surgery. The study further concluded
that the earlier the surgical intervention,
the more likely it is to have a lasting effect
on type 2 diabetes.
Two recent landmark studies in The New
England Journal of Medicine demonstrate that
bariatric operations reduce long-term mortality
associated with obesity. One study by
Dr. Ted Adams from the University of Utah
compared two cohorts of severely obese
patients, approximately 4,000 patients
each. 11 One group had Roux-en-Y gastric
ILLUSTRATION COURTESY OF CLEVELAND CLINIC
1 2 | | GREATER AKRON/CANTON M.D. NEWS JANUARY-FEBRUARY 2008