Bariatric Surgery Best for Obese Diabetics

All patients got intensive medical therapy according to American Diabetes Association guidelines with lifestyle counseling, weight management (recommended to include Weight Watchers), and newer diabetes drugs, such as the incretin analogues. Glycosylated hemoglobin levels fell rapidly in the first 3 months after surgery. By 1 year, they reached a mean 6.4% after gastric bypass and 6.6% after sleeve gastrectomy compared with 7.5% with medical therapy alone (P<0.001 and P=0.003).
Bariatric Surgery Contraindications Contraindications to bariatric surgery include illnesses that greatly reduce life expectancy and are unlikely to be improved with weight reduction, including advanced cancer and end-stage renal, hepatic, and cardiopulmonary disease. Patients who are unable to understand the nature of bariatric surgery or the behavioral changes required afterward, including untreated schizophrenia, active substance abuse, and noncompliance with previous medical care, are also considered contraindications to bariatric surgery.
For the primary endpoint of a glycosylated hemoglobin under 6.0% at 1 year, the two bariatric surgery groups came up equal (P=0.59), though all who achieved that target in the gastric bypass group did so off diabetes medications versus 28% in the sleeve gastrectomy group.
Laparoscopic Gastric Bypass More than 100 million Americans (65% of the adult population) are overweight. Obesity is the second leading cause of preventable death in the United States after smoking. Annually, obesity-related diseases account for 400,000 of premature deaths. A combination of genetics, environmental issues, and behavioral factors may contribute to the condition. Consumption of high-calorie foods, consumption of too much food, and a sedentary lifestyle all work together to create this condition. Obesity is associated with the development of diabetes mellitus, hypertension, dyslipidemia, arthritis, sleep apnea, cholelithiasis, cardiovasculardisease, and cancer. Morbid obesity is defined assevereobesitythatthreatensone’shealth and can shorten lifespan. Obesity can be treated medically and surgically. Medical treatment for obesity is difficult, because the amount of weight lost is small and patients tend to regain most of the weight. Operations designed to result in significant and long-lasting weight loss in patients who are severely obese are called bariatric surgery. The term bariatric surgery is derived from the Greek words baros (weight) and iatreia (medical treatment). Laparoscopic gastric bypass surgery, described here, is one such surgery. It involves creating a gastric pouch. Body mass index (BMI) describes relative weight for height and correlates significantly with an individual’s total body fat. BMI is based on height and weight and applies to adults of both sexes. BMI is calculated as follows: BMI equals weight in kg/height in m2 or weight in lb/height in square inches.
Not surprisingly, weight loss after gastric bypass and sleeve gastrectomy exceeded that of medical therapy alone over 1 year (-64.8 and -55.3 lb versus -11.9 lb, both P<0.001). Gastric bypass cut weight as well as BMI significantly more than sleeve gastrectomy (P=0.02 and 0.03, respectively). "Reductions in the use of diabetes medications occurred before achievement of maximal weight loss, which supports the concept that the mechanisms of improvement in diabetes involve physiologic effects in addition to weight loss, probably related to alterations in gut hormones," Shauer's group noted. Medication use to control glucose, lipids, and blood pressure fell significantly after both surgeries but increased with medical therapy alone. Metabolic syndrome and insulin resistance also improved more with the bariatric procedures. No patients died or had a life-threatening complication, though four patients required additional surgical interventions. The study wasn't powered to look for differences between the surgical arms or for clinical outcomes, though cardiovascular risk factors did improve. Limitations included the short follow-up and the open-label assessment of patients at a single center.
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