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      Metabolic Surgery for Type 2 Diabetes with BMI <35 kg/m 2 : An Endocrinologist’s Perspective

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      Publication date (Electronic):
      Journal: Obesity Surgery
      Publisher: Springer-Verlag
      Keywords: Metabolic surgery, Type 2 diabetes, Body mass Index <35 kg/m2, Remission of diabetes

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          Abstract

          Is bariatric surgery as primary therapy for type 2 diabetes mellitus (T2DM) with body mass index (BMI) <35 kg/m 2 justified? Open-label studies have shown that bariatric surgery causes remission of diabetes in some patients with BMI <35 kg/m 2. All such patients treated had substantial weight loss. Diabetes remission was less likely in patients with lower BMI than those with higher BMI, in patients with longer than shorter duration and in patients with lesser than greater insulin reserve. Relapse of diabetes increases with time after surgery and weight regain. Deficiencies of data are lack of randomized long-term studies comparing risk/benefit of bariatric surgery to contemporary intensive medical therapy. Current data do not justify bariatric surgery as primary therapy for T2DM with BMI <35 kg/m 2.

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          Disordered lipid metabolism and the pathogenesis of insulin resistance.

          David B. Savage, Kitt Falk Petersen, Gerald I. Shulman (2007)
          Although abnormal glucose metabolism defines type 2 diabetes mellitus (T2DM) and accounts for many of its symptoms and complications, efforts to understand the pathogenesis of T2DM are increasingly focused on disordered lipid metabolism. Here we review recent human studies exploring the mechanistic links between disorders of fatty acid/lipid metabolism and insulin resistance. As "mouse models of insulin resistance" were comprehensively reviewed in Physiological Reviews by Nandi et al. in 2004, we will concentrate on human studies involving the use of isotopes and/or magnetic resonance spectroscopy, occasionally drawing on mouse models which provide additional mechanistic insight.
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            Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus.

            Philip Schauer, Bartolomé Burguera, Sayeed Ikramuddin … (2003)
            To evaluate pre- and postoperative clinical parameters associated with improvement of diabetes up to 4 years after laparoscopic Roux-en-Y gastric bypass (LRYGBP) in patients with type 2 diabetes mellitus (T2DM). The surgical treatment of morbid obesity leads to dramatic improvement in the comorbidity status of most patients with T2DM. However, little is known concerning what preoperative clinical factors are associated with postoperative long-term improvement in diabetes in the morbidly obese patient with diabetes. METHODS We evaluated pre- and postoperative data, including demographics, duration of diabetes, metabolic parameters, and clinical outcomes, in all patients with impaired fasting glucose (IFG) and type T2DM undergoing LRYGBP from July 1997 to May 2002. During this 5-year period, 1160 patients underwent LRYGBP and 240 (21%) had IFG or T2DM. Follow up was possible in 191 of 240 patients (80%). There were 144 females (75%) with a mean preoperative age of 48 years (range, 26-67 years). After surgery, weight and body mass index decreased from 308 lbs and 50.1 kg/m2 to 211 lbs and 34 kg/m2 for a mean weight loss of 97 lbs and mean excess weight loss of 60%. Fasting plasma glucose and glycosylated hemoglobin concentrations returned to normal levels (83%) or markedly improved (17%) in all patients. A significant reduction in use of oral antidiabetic agents (80%) and insulin (79%) followed surgical treatment. Patients with the shortest duration (<5 years), the mildest form of T2DM (diet controlled), and the greatest weight loss after surgery were most likely to achieve complete resolution of T2DM. LRYGBP resulted in significant weight loss (60% percent of excess body weight loss) and resolution (83%) of T2DM. Patients with the shortest duration and mildest form of T2DM had a higher rate of T2DM resolution after surgery, suggesting that early surgical intervention is warranted to increase the likelihood of rendering patients euglycemic.
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              Bariatric surgery: risks and rewards.

              Walter J. Pories (2008)
              Over 23 million Americans are afflicted with severe obesity, i.e. their body mass index (in kilograms per square meter) values exceed 35. Of even greater concern is the association of the adiposity with comorbidities such as diabetes, hypertension, cardiopulmonary failure, asthma, pseudotumor cerebri, infertility, and crippling arthritis. Diets, exercise, behavioral modification, and drugs are not effective in these individuals. This article examines the effect of surgery on the control of the weight and the comorbidities, as well as the safety of these operations. Although the article focuses on the outcomes of the three most commonly performed operations, i.e. adjustable gastric banding, the gastric bypass, and the biliopancreatic bypass with duodenal switch, it aims for perspective with the inclusion of abandoned and current investigational procedures, a review of the complications, and an emphasis on the appropriate selection of patients. POSITIONS: Ample evidence, including controlled randomized studies, now document that bariatric surgery produces durable weight loss exceeding 100 lb (46 kg), full and long-term remission of type 2 diabetes in over 80% with salutary effects on the other comorbidities as well with significant reductions in all-cause mortality. Although the severely obese present with serious surgical risks, bariatric surgery is performed safely with a 0.35% 90-d mortality in Centers of Excellence throughout the United States-similar to the complication rates after cholecystectomy. Until better approaches become available, bariatric surgery is the therapy of choice for patients with severe obesity.
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                Author and article information

                Contributors
                : hlebovitz1@hotmail.com
                Journal
                Journal ID (nlm-ta): Obes Surg
                Journal ID (iso-abbrev): Obes Surg
                Title: Obesity Surgery
                Publisher: Springer-Verlag (New York )
                ISSN (Print): 0960-8923
                ISSN (Electronic): 1708-0428
                Publication date (Electronic): 22 March 2013
                Publication date PMC-release: 22 March 2013
                Publication date (Print): June 2013
                Volume: 23
                Issue: 6
                Pages: 800-808
                Affiliations
                Department of Medicine, State University of New York Health Science Center at Brooklyn, Brooklyn, NY USA
                Article
                Publisher ID: 907
                DOI: 10.1007/s11695-013-0907-1
                PMC ID: 3653036
                PubMed ID: 23515973
                SO-VID: 607ff6a8-d8e4-4c04-9701-a154ea6288cf
                Copyright © © The Author(s) 2013
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

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                Subject: Review
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                issue-copyright-statement © Springer Science+Business Media New York 2013

                ScienceOpen disciplines: Surgery
                Keywords: metabolic surgery,type 2 diabetes,body mass index <35 kg/m2,remission of diabetes
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: metabolic surgery, type 2 diabetes, body mass index <35 kg/m2, remission of diabetes

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