The Role of Bariatric Surgery in the Resolution of Type 2 Diabetes Mellitus
Keywords:
medicineAbstract
Obesity is a major risk factor for many diseases, most notably for type 2 diabetes. Due to this correlation, weight
loss has been a primary objective in managing type 2 diabetes. Current medical weight loss therapies and
programs have proved disappointing, presenting an increasingly frustrating problem for the obese and diabetic
population. At present, bariatric surgery is the most effective treatment for obesity and type 2 diabetes by
inducing significant, long-term weight reduction. The cornerstone for inducing weight loss in these procedures
comprises elements of gastric restriction, malabsorption by means of bypassing the foregut, or a combination of
both. Depending on the type of bariatric procedure, observation of euglycaemia has been found in 48% to 99%
of cases following surgery, therefore proving to be far more superior in treating obesity and type 2 diabetes in
comparison to nonsurgical methods. While weight loss may seem like the most reasonable explanation in the
improved glycaemic control, several findings have suggested the involvement of other factors. Interestingly, the
alterations of various gastrointestinal hormones imparted by the malabsorptive procedures appear to be the
dominant feature in the resolution of type 2 diabetes. This article provides an overview of the various bariatric
procedures and the physiological mechanisms that contribute to the weight loss and cure of type 2 diabetes after
surgery
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Suppressor of cytokine signalling 3 is a physiological regulator
of adipocyte insulin signalling. J Biol Chem, 279(33): 34733-40.
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energy balance: visceral allies in the obesity wars. Science,
307(5717), 1909-14.
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adipose tissue: their relation to the metabolic syndrome.
Endocr Rev, 21(6), 697-738.
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Wang, J., & Rossetti, L. (1999 Jan). Surgical removal of
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glucose intolerance of aging: an adipokine-mediated process?
Diabetes, 51(10), 2951-8.
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body fat distribution and the modulation of insulin action. Int J
Obes Relat Metab Disord, 24 Suppl 4, S63-6.
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Nov-Dec). National trends in utilization and in-hospital
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60; discussion 861.
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Obesity is a surgical disease: overview of obesity and bariatric
surgery. ANZ J Surg, 74(4), 200-4.
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Obesity, weight loss and bariatric surgery. Med J Aust, 183(6),
310-4.
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obesity. Consensus Development Conference Panel. Ann Intern
Med, 115:956-961.
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(2004 Jun). Gastric bypass for obesity: mechanisms of weight
loss and diabetes resolution. J Clin Endocrinol Metab, 89(6),
2608-15.
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obesity. Am J Surg, 118:141-147
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surface caries: a complication of the jejunoileal bypass. Obes
Surg, 10(1), 33-6.
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Management of obesity--the role of surgery. Aust Fam
Physician, 35(8), 584-6.
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severe obesity. Mt Sinai J Med, 71(1), 63-71.
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Biliopancreatic diversion. World J Surg, 22:936-946.
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Update on obesity surgery. World J Gastroenterol, 12(20),
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for adult-onset diabetes mellitus. Ann Surg, 222(3), 339-50;
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Feb). Gastric bypass for treating severe obesity. Am J Clin
Nutr, 55(2 Suppl):560S-566S.
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control of morbid obesity. JAMA, 288(22), 2793-6.
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banded gastroplasty as primary operation for morbid obesity. J
Gastrointest Surg, 4(6), 598-605.
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adjustable gastric banding in the treatment of obesity: a
systematic literature review. Surgery 2004; 135: 326-351.
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rate after laparoscopic adjustable silicone gastric banding for
treatment of morbid obesity. Ann Surg 2001; 233(6):809 . 818.
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Weight loss and improvement of obesity-related illness in 500
U.S. patients following laparoscopic adjustable gastric banding
procedure. Am J Surg, 189(1), 27-32.
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Three-year follow-up weight loss results for patients undergoing
laparoscopic adjustable gastric banding at a major university
medical center: does the weight loss persist? Am J Surg,
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http://www.who.int/diabetesactiononline/diabetes/basics/en/inde
x.html.
2. Wild, S., Roglic, G., Green, A., Sicree, R., & King, H. (2004
May). Global prevalence of diabetes: estimates for the year
2000 and projections for 2030. Diabetes Care, 27(5), 1047-53.
3. Brethauer, S. A., Chand, B., & Schauer, S. A. (2006 Nov).
Risks and benefits of bariatric surgery: current evidence. Cleve
Clin J Med, 73(11), 993-1007.
4. Eisenberg, D.; Bell, R.L. (2003). The Impact of Bariatric
Surgery on Severely Obese Patients With Diabetes. Diabetes
Spectrum, 16(4), 240-245.
5. Schneider, B. E., & Mun, B. E. (2005 Feb). Surgical
management of morbid obesity. Diabetes Care, 28(2), 475-80.6. Avenell, A., Broom, J., Brown, T. J., Poobalan, A., Aucott, L.,
Stearns, T. J., Smith, T. J., Jung, T. J., Campbell, T. J., & Grant,
T. J. (2004 May). Systematic review of the long-term effects
and economic consequences of treatments for obesity and
implications for health improvement. Health Technol Assess,
8(21), iii-iv, 1-182.
7. Mokdad, A. H., Serdula, A. H., Dietz, A. H., Bowman, A. H.,
Marks, A. H., & Koplan, A. H. (1999 Oct 27). The spread of the
obesity epidemic in the United States, 1991-1998. JAMA,
282(16), 1519-22.
8. Mokdad, A. H., Ford, A. H., Bowman, A. H., Dietz, A. H.,
Vinicor, F., Bales, A. H., & Marks, A. H. (2003 Jan 1).
Prevalence of obesity, diabetes, and obesity-related health risk
factors, 2001. JAMA, 289(1), 76-9.
9. American Diabetes Association: Nutrition recommendations
and principles for people with diabetes mellitus (Position
Statement). (2001). Diabetes Care 24:S44-S47.
10. Wing R, Koeske R, Epstein L, Nowalk MP, Gooding W,
Becker D (1987). Long-term effects of modest weight loss in
type II diabetic patients. Arch Intern Med 147:1749-1753.
11. Miles, J. M., Leiter, L., Hollander, P., Wadden, T., Anderson,
J. M., Doyle, M., Foreyt, J., Aronne, L., & Klein, S. (2002 Jul).
Effect of orlistat in overweight and obese patients with type 2
diabetes treated with metformin. Diabetes Care, 25(7), 1123-8.
12. Redmon, J. B., Reck, J. B., Raatz, J. B., Swanson, J. B.,
Kwong, J. B., Ji, H., Thomas, W., & Bantle, J. B. (2005 Jun).
Two-year outcome of a combination of weight loss therapies for
type 2 diabetes. Diabetes Care, 28(6), 1311-5.
13. Kazaks, A., & Stern, J. S. (2003). Obesity Treatments and
Controversies. Diabetes Spectrum, 16(4), 231-235.
14. Wing RR, Marcus MD, Epstein LH, Salata R (1987). Type II
diabetic subjects lose less weight than their overweight
spouses. Diabetes Care 10:536-536, 1987
15. Detournay B, Cros S, Charbonnel B, et al. Managing type 2
diabetes in France: the ECODIA survey. Diabetes Metab 2000;
26:363-369.
16. Watts NB, Spanheimer RG, DiGirolamo M, Gebhart SS,
Musey VC, Siddiq YK, Phillips LS. Prediction of glucose
response to weight loss in patients with non-insulin dependent
diabetes mellitus. Arch Intern Med 1990; 151: 198-201.
17. Buchwald, H., Avidor, Y., Braunwald, E., Jensen, M. D.,
Pories, W., Fahrbach, K., & Schoelles, K. (2004 Oct 13).
Bariatric surgery: a systematic review and meta-analysis.
JAMA, 292(14), 1724-37.
18. Lazar, M. A. (2005 Jan 21). How obesity causes diabetes:
not a tall tale. Science, 307(5708), 373-5.
19. Koerner A, Kratzsch J, Kiess W. (2005). Adipocytokines:
leptin--the classical, resistin--the controversial, adiponectin--the
promising, and more to come. Best Pract Res Clin Endocrinol
Metab 2005; 19: 525-546.
20. Considine R.V., Sinha M.K., Heiman M.L., et al. (1996).
Serum immunoreactive-leptin concentrations in normal-weight
and obese humans. N Engl J Med, 334: 292-295.
21. Friedman, J.M. (2002 Oct). The function of leptin in
nutrition, weight, and physiology. Nutr Rev, 60(10 Pt 2): S1-14;
discussion S68-84, 85-7.
22. Howard, J.K., Cave, B.J., Oksanen, L.J., Tzameli, I.,
Bjorbaek, C., Flier, J.S. (2004 Jul). Enhanced leptin sensitivity
and attenuation of diet-induced obesity in mice with
haploinsufficiency of Socs3. Nat Med, 10(7):734-8.
23. Shi, H., Tzameli, I., Bjorbaek, C., Flier, J.S. (2004 Aug 13).
Suppressor of cytokine signalling 3 is a physiological regulator
of adipocyte insulin signalling. J Biol Chem, 279(33): 34733-40.
24. Badman, M. K., & Flier, M. K. (2005 Mar 25). The gut and
energy balance: visceral allies in the obesity wars. Science,
307(5717), 1909-14.
25. Wajchenberg, B.L. (2000 Dec). Subcutaneous and visceral
adipose tissue: their relation to the metabolic syndrome.
Endocr Rev, 21(6), 697-738.
26. Barzilai, N., She, L., Liu, B. Q., Vuguin, P., Cohen, P.,
Wang, J., & Rossetti, L. (1999 Jan). Surgical removal of
visceral fat reverses hepatic insulin resistance. Diabetes, 48(1),
94-8.27. Gabriely, I., Ma, X. H., Yang, X. H., Atzmon, G., Rajala, X.
H., Berg, X. H., Scherer, P., Rossetti, L., & Barzilai, N. (2002
Oct). Removal of visceral fat prevents insulin resistance and
glucose intolerance of aging: an adipokine-mediated process?
Diabetes, 51(10), 2951-8.
28. Cases, J. A., & Barzilai, N. (2000 Nov). The regulation of
body fat distribution and the modulation of insulin action. Int J
Obes Relat Metab Disord, 24 Suppl 4, S63-6.
29. Pope, G. D., Birkmeyer, G. D., & Finlayson, G. D. (2002
Nov-Dec). National trends in utilization and in-hospital
outcomes of bariatric surgery. J Gastrointest Surg, 6(6), 855-
60; discussion 861.
30. O'Brien, P. E., Dixon, P. E., & Brown, W. (2004 Apr).
Obesity is a surgical disease: overview of obesity and bariatric
surgery. ANZ J Surg, 74(4), 200-4.
31. O'Brien, P. E., Brown, P. E., & Dixon, P. E. (2005 Sep 19).
Obesity, weight loss and bariatric surgery. Med J Aust, 183(6),
310-4.
32. NIH conference. (1991). Gastrointestinal surgery for severe
obesity. Consensus Development Conference Panel. Ann Intern
Med, 115:956-961.
33. Cummings, D. E., Overduin, J., & Foster-Schubert, D. E.
(2004 Jun). Gastric bypass for obesity: mechanisms of weight
loss and diabetes resolution. J Clin Endocrinol Metab, 89(6),
2608-15.
34. Payne J.H., DeWind L.T. (1969). Surgical treatment of
obesity. Am J Surg, 118:141-147
35. Greenway, S. E., & Greenway, S. E. (2000 Feb). Root
surface caries: a complication of the jejunoileal bypass. Obes
Surg, 10(1), 33-6.
36. Brown, W., Dixon, J. B., & Brien, J. B. (2006 Aug).
Management of obesity--the role of surgery. Aust Fam
Physician, 35(8), 584-6.
37. Herron, D. M. (2004 Jan). The surgical management of
severe obesity. Mt Sinai J Med, 71(1), 63-71.
38. Scopinaro N., Adami G.F., Marinari G.M., et al. (1998).
Biliopancreatic diversion. World J Surg, 22:936-946.
39. Eisenberg, D., Duffy, A. J., & Bell, A. J. (2006 May 28).
Update on obesity surgery. World J Gastroenterol, 12(20),
3196-203.
40. Marceau, P., Hould, F. S., Simard, S., Lebel, S., Bourque, F.
S., Potvin, M., & Biron, S. (1998 Sep). Biliopancreatic diversion
with duodenal switch. World J Surg, 22(9), 947-54.41.Wolfe, B.
M., & Morton, B. M. (2005 Oct 19). Weighing in on bariatric
surgery: procedure use, readmission rates, and mortality.
JAMA, 294(15), 1960-3.
42. Santry, H. P., Gillen, H. P., & Lauderdale, H. P. (2005 Oct
19). Trends in bariatric surgical procedures. JAMA, 294(15),
1909-17.
43. Pories, W. J., Swanson, W. J., MacDonald, W. J., Long, W.
J., Morris, W. J., Brown, W. J., Barakat, W. J., deRamon, W. J.,
Israel, G., Dolezal, W. J., & al., e. (1995 Sep). Who would have
thought it? An operation proves to be the most effective therapy
for adult-onset diabetes mellitus. Ann Surg, 222(3), 339-50;
discussion 350-2.
44. Sugerman, H.J., Kellum, J.M., Engle, K.M., et al. (1992
Feb). Gastric bypass for treating severe obesity. Am J Clin
Nutr, 55(2 Suppl):560S-566S.
45. Brolin, R. E. (2002 Dec 11). Bariatric surgery and long-term
control of morbid obesity. JAMA, 288(22), 2793-6.
46. Balsiger, B. M., Poggio, B. M., Mai, J., Kelly, B. M., & Sarr,
B. M. (2000 Nov-Dec). Ten and more years after vertical
banded gastroplasty as primary operation for morbid obesity. J
Gastrointest Surg, 4(6), 598-605.
47. Chapman A, Kiroff G, Game P, et al. Laparoscopic
adjustable gastric banding in the treatment of obesity: a
systematic literature review. Surgery 2004; 135: 326-351.
48. DeMaria EJ, Sugerman HJ, Meador JG, et al. High failure
rate after laparoscopic adjustable silicone gastric banding for
treatment of morbid obesity. Ann Surg 2001; 233(6):809 . 818.
49. Chevallier, J. M., Zinzindohoue, F., Elian, N., Cherrak, A.,
Blanche, J. M., Berta, J. M., Altman, J. M., & Cugnenc, J. M.
(2002 Feb). Adjustable gastric banding in a public university
hospital: prospective analysis of 400 patients. Obes Surg,
12(1), 93-9.
50. Fielding, G. A., Rhodes, M., & Nathanson, G. A. (1999 Jun).
Laparoscopic gastric banding for morbid obesity. Surgical
outcome in 335 cases. Surg Endosc, 13(6), 550-4.
51. Kuzmak LI. A review of seven years' experience with
silicone gastric banding. Obes. Surg. 1991; :1 403-8.
52. Spivak, H., Hewitt, M. F., Onn, A., & Half, M. F. (2005 Jan).
Weight loss and improvement of obesity-related illness in 500
U.S. patients following laparoscopic adjustable gastric banding
procedure. Am J Surg, 189(1), 27-32.
53. Sarker, S., Myers, J., Serot, J., & Shayani, V. (2006 Mar).
Three-year follow-up weight loss results for patients undergoing
laparoscopic adjustable gastric banding at a major university
medical center: does the weight loss persist? Am J Surg,
191(3), 372-6.
54. Rubino, F., & Gagner, M. (2002 Nov). Potential of surgery
for curing type 2 diabetes mellitus. Ann Surg, 236(5), 554-9.
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2007-01-01
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Khan, Y. (2007). The Role of Bariatric Surgery in the Resolution of Type 2 Diabetes Mellitus. Trinity Student Medical Journal , 8(1). Retrieved from https://ojs.tchpc.tcd.ie/index.php/tsmj/article/view/1844
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