MDNews - Cleveland-Akron-Canton

++++++++++++++++++++++++++++++++++++++++++++++ + + ++++++++++++++++++++++++++++++++++++++++++++++ SPECIAL SECTION: DIABETES AND OBESITY  +++ +++ A RESOLUTION FOR TYPE 2 DIABETES? By Aviv Ben-Meir, MD, and Joumana T. Chaiban, MD Surgery: Bariatric the rise in the prevalence of obesity. The simultaneous rise in these two diseases has resulted in a new term, ‘diabesity.’ Overweight or obese individuals develop M insulin resistance with resultant hyperin- sulinemia. This process may progress to impaired glucose tolerance and eventual type 2 diabetes. Approximately 30 percent of patients seen at the Center for Bariatric Surgery at St. Vincent Charity Medical Center have type 2 diabetes. Interestingly, there is strong evidence indicating that bariatric surgery may not only produce sustainable long-term weight loss in obese individuals, but resolve type 2 diabetes. The Roux-en-Y Gastric Bypass, a combination restrictive and malabsorp- tive operation and the Vertical Sleeve Gastrectomy, a purely restrictive operation, are extremely effective in accomplishing this and can be performed laparoscopically. Two significant observations have been made in diabetic patients undergo- ing bariatric surgery. First, a marked improvement in glycemic control has been shown to occur almost immediately following bariatric surgery even before any weight loss. This suggests that weight loss alone is not the only reason for the resolution of type 2 diabetes. These operations have resulted in approxi- mately 80 percent of patients achieving normoglycemia. Second, the resolution of type 2 diabetes is attributed to the ORE THAN 220 million indi- viduals worldwide have type 2 diabetes. These numbers are attributed in large part to complex alteration in secretion of gut hormones. Post-bariatric surgery, the secretion of GLP1 and GIP hormones by the stomach is altered, leading to rapid improvement of blood sugar. Patient Example A 60-year-old female came to a bar- iatric surgery consultation weighing 302 pounds with a BMI of 50 and co-morbid conditions including: type 2 diabetes, hypertension, DJD and sleep apnea. Twelve months after having a Vertical However, the medication functions only as a type 2 diabetes management tool and does not lead to the resolution of the disease, nor does it lead to the significant weight loss compared with bariatric surgery. Bariatric surgery remains the most successful treatment for diabesity, causing durable weight loss, proven reduction in co-morbidities such as sleep apnea, high blood pressure, cardiac dysfunction and resolution of type 2 diabetes. “A marked improvement in glycemic control has been shown to occur almost immediately following bariatric surgery even before any weight loss.” Sleeve Gastrectomy, she lost 175 pounds, more than 93 percent of her excess body weight and now has a BMI of 24. All of her co-morbidities, including type 2 diabetes have resolved. Alternative to Surgery Bariatric surgery may not be the only option for patients suffering from diabesity. Exenatide, also known by the trade name Byetta, is used to help obese patients control type 2 diabetes. Given subcutaneously, twice a day, exenatide mimics GLP1, hence break- ing the insulin-resistant cycle of type 2 diabetes, and leads to weight loss. 44 | Cleveland-Akron-Canton MD NEWS  MDNEWS.COM  JULY-AUGUST 2011 With technological advances and an increase in the number of operations being performed each year, these opera- tions have become lower risk and offer patients suffering from obesity and co- morbidities a longer, higher-quality life. As the prevalence of obesity and type 2 diabetes continues to rise, so, too, may the role of bariatric surgery in combating this growing epidemic. Dr. Aviv Ben-Meir is medical director of the Center for Bariatric Surgery, and Dr. Joumana Chaiban is medical director of the Joslin Diabetes Center, at St. Vincent Charity Medical Center in Cleveland. n

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