DOCTOR'S VIEW ARCHIVE
Diabetes Update #11 Day 4, Monday June 13 from the American Diabetes Association National Meeting
Dr. Ruchi Mathur offers perspectives of interest on topics from the American Diabetes Association's 65th Annual Scientific Sessions (held in San Diego, California June 10-14, 2005)
This is Dr. Ruchi Mathur at the American Diabetes Associations 65th Scientific Symposia. One of the topics today presented today that I'd like to talk to you about is the role of gastric bypass in the treatment of diabetes.
This was the topic of a 2-hour symposia this afternoon. Basically- there are 2 main approaches to gastric surgery for obesity: A bypass- also called a roux en y procedure, and gastric banding. The first avoids a section of the absorptive surface of the intestine, and the second seals of a large portion of the stomach making the functional portion quite small and easily filled.
Well- who is a candidate for these procedures? Usually patients with a BMI of over 40 or over 35 with health consequences that are obesity related. Does gastric bypass have any effect on diabetes? In a series of 1000 patients, 150 of whom had diabetes, 83% experienced resolution of their diabetes (defined by a normalization of A1c and coming of medications for diabetes) after the surgery.
What predicted success in these patients? In another study of 191 patients followed out to 5 years after surgery, a shorter duration of diabetes lead to a better A1c outcome, and a lower weight post operatively also lead to a better A1c. In this series, 80% came of oral medications for diabetes, 84% of those who stayed on meds after surgery reduced their dosing, 79% came off insulin of those still requiring insulin 90% dropped their dose. With regards to the gastric banding procedure, in a study of 66 patients, A1c dropped from an average of 6.3 preoperatively to 5.3 post operatively.
So- what does this mean? In a metanalysis review published in JAMA in 2004 the authors stated that there was resolution of diabetes in an average of 70% of patients after bypass, and gastric banding was also effective, though slightly less so.
The question is whether these effects are directly related to weight loss or a decrease in nutrient intake, or if there is another mechanism at play. This was enthusiastically discussed in much detail. What does all this mean to you? If you are an obese patient with diabetes, gastric bypass may help control your metabolic disregulation and your glycemic profile. However, these surgeries are not without risk nor are they without side effects. If you are interested in this option, bring it up with your physician (because chances are your physician won't). Physicians are notorious for not dealing with weight issues with their patients. Get a contact with a skilled surgeon familiar and well versed in these procedures for a full consult. Aim for a referral to an academic center that has a team of nutritionists, gastroenterologists, psychologists, and diabetologists to help with the perioperative period. And remember that lifestyle will still need to come into play regardless of any other treatment option for diabetes. Read and hear the next installment from the conference.
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