Impact of bariatric surgery on type 2 diabetes

Luigi Fernando Meneghini

Research output: Contribution to journalArticle

32 Scopus citations

Abstract

The management and prevention of diabetes through lifestyle modifications and weight loss should be the mainstay of therapy in appropriate candidates. Although the results from the Diabetes Prevention Trial and the Finnish Prevention Study support this approach, over 95% of patients not participating in a prevention research study are unable to achieve and maintain any significant weight loss over time. Bariatric surgery for weight loss is an emerging option for more sustainable weight loss in the severely obese subject, especially when obesity is complicated by diabetes or other co-morbidities. The two most common types of procedures currently used in the United States are adjustable gastric bands and Roux-en-Y gastric bypass. These procedures can be performed laparoscopically, further reducing the perioperative morbidity and mortality associated with the surgery. While the gastric bypass procedure usually results is greater sustained weight loss (40-50%) than adjustable gastric banding (20-30%), it also carries greater morbidity and nutritional/metabolic issues, such as deficiencies in iron, B12, calcium, and vitamin D. Following bariatric surgery most subjects experience improvements in diabetes control, hypertension, dyslipidemia, and other obesity-related conditions. In patients with impaired glucose tolerance most studies report 99-100% prevention of progression to diabetes, while in subjects with diabetes prior to surgery, resolution of the disease is reported in 64-93% of the cases. While improvements in insulin resistance and beta-cell function are related to surgically induced weight loss, the rapid post-operative improvement in glycemia is possibly due to a combination of decreased nutrient intake and changes in gut hormones as a result of the bypassed intestine. Post-prandial hyperinsulinemic hypoglycemia associated with nesidioblastosis has been described in a series of patients following gastric bypass surgery, and may be related to the described changes in GLP-1 and other gut hormones.

Original languageEnglish (US)
Pages (from-to)97-102
Number of pages6
JournalCell Biochemistry and Biophysics
Volume48
Issue number2-3
DOIs
StatePublished - Jun 1 2007

Keywords

  • Bariatric surgery
  • Diabetes
  • Gastric banding
  • Gastric bypass
  • Glucagon-like Peptide 1 (GLP-1)
  • Impaired glucose tolerance
  • Weight loss

ASJC Scopus subject areas

  • Cell Biology
  • Clinical Biochemistry
  • Biophysics
  • Biochemistry

Fingerprint Dive into the research topics of 'Impact of bariatric surgery on type 2 diabetes'. Together they form a unique fingerprint.

  • Cite this