Wednesday, March 16, 2011

Bariatric Surgery: A Primary Treatment for Type ll Diabetes

Bariatric or weight loss surgery is considered, by many, to be an important option for treating obesity. And recently, the FDA lowered the BMI guidelines for lap band surgery, a popular form of weight loss surgery. Up until the FDA's action, an individual's BMI had to be at least 35 before bariatric surgery would be indicated. Now, FDA lap band surgical BMI guidelines have a lower limit of 30, provided the patient has specific health-related comorbidities, including hypertension and diabetes. Further, the treatment usages for bariatric surgery could broaden. Studies are now underway to determine the effectiveness of bariatric surgery for type II diabetes.

It has been known for some time that bariatric surgery causes improvement in conditions associated with type II diabetes. In some cases, it appears that the surgery resolves the disease. Well, one study, being done at New York Presbyterian Hospital/Weill Cornell medical Center, is trying to determine if "bariatric surgery is the best option for type II diabetes."

As we indicated above, type II diabetes is one of the comorbidities among the FDA guidelines, used to justify bariatric surgery. The above mentioned study will be open to diabetic patients with a BMI as low as 26. Fifty patients are to be enrolled in the study. And among other things, the study leaders hope that their results will lead to improved methods of treating type II diabetes, and lead to a deeper understanding of how gut hormones respond to the food we eat. A better understanding of gut-hormone response to food could lead to improved weight loss and diabetes therapies.
The hormone, GLP-1 (glucon-like peptide 1), is one of the gut hormones being investigated by researchers. In fact, a group in the UK has concluded that within days after gastric bypass surgery, "improved insulin resistance, insulin production, and GLP 1 responses" occurred. And the group speculates that the increased insulin production may be associated with "enhanced ... GLP-1 responses."
The UK group also determined that lap band surgery led to type II diabetes remission in 72% of the gastric bypass patients, and in 17% of the lap band patients.
At any rate, one day there may be a legitimate basis for using some form of bariatric surgery as a primary treatment of type II diabetes. And presurgical and postsurgical medical intervention will likely be important to resolving the disease. So bariatric physicians, as well as bariatric surgeons, will be important actors in the process.
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