Dr. Marc Zerey is a board certified physician specializing in bariatric weight loss and advanced laproscopic surgical techniques. Dr. Zerey has published extensively including journal articles in American Surgeon, American Journal of Surgery, American Journal of Surgical Research and is an ASMBS Bariatric Surgery Center of Excellence designee. The Bariatric Surgery Center can be reached at (805) 898-3472.
For the millions of Americans suffering from diabetes, keeping the disease in check means being careful about what you eat, monitoring your glucose, and taking medications (sometimes several). Failure to achieve diabetic control can lead to severe health complications such as kidney failure, blindness, heart disease, and peripheral vascular disease, which can eventually result in the need for amputations.
The majority of diabetics suffer from so-called type 2 diabetes which is strongly correlated with obesity. Weight loss is strongly correlated with resolution of health problems, including type 2 diabetes. For people undergoing weight loss surgery, however, the resolution of diabetes may not be correlated with weight loss.
When I was a resident, gastric bypass surgery was still being performed via laparotomy (one large incision). People would stay in the hospital for longer periods of time than they do today (sometimes up to one week or longer). What was interesting was that when we monitored their glucose, we could see their levels decrease over the few days they were in hospital — far outpacing the weight-loss associated with the procedure.
The same continues today when we do the surgery laparoscopically. As opposed to most other medical problems associated with obesity (hypertension, sleep apnea, high cholesterol, etc.) type 2 diabetes is often cured independent of weight-loss.
It is not entirely clear why this occurs. Some studies suggest that changes in gut hormones mediate the effects of the surgical procedure. Why these changes occur remains a matter of debate. For patients undergoing gastric bypass surgery, this is likely due in part to exclusion of food from a specific part of the small intestine, which contains receptors that mediate the levels of these hormones. It is believed that these changes may improve the body's ability to process insulin and glucose. Not surprisingly, the pharmaceutical industry has taken note and is actively trying to replicate these effects in pill form.
This poses several interesting questions. Should we start looking at surgery for people with type 2 diabetes who are not obese? Is this cost-effective? In my opinion, if rigorous scientific trials were to demonstrate significant clinical benefit in this group of patients, then we should consider offering the surgical option. What do you think?