Little is known of the long-term effects associated with a resolution of T2D (Type II Diabetes - formerly known as Noninsulin-Dependent Diabetes Mellitus or NIDDM) in patients who've undergone Gastric-Bypass Surgery and other weight loss surgeries. More and more research is surfacing in both academic circles as well as local, public news sources about the many immediate benefits of metabolic and bariatric surgeries. One such benefit is the remission of T2D among the very obese (those with a BMI>40) who have had the disease for more than one year since initial diagnosis. Dr. Walter Pories, considered a pioneer in such research, first published findings of his research in 1992, suggesting that due to [Greenville] gastric bypass surgery 107 of his 137 obese T2D patients went into clinical remission (1). Fast-forward 20 years and there are similar findings among those in both diabetes and bariatric research. Unfortunately however, little is still known as to why this happens. The ASMBS (American Society for Metabolic and Bariatric Surgery) states, "Many patients with [T2D] experience complete remission within days of metabolic surgery, long before significant weight comes off" (2). Because of such observations and results after surgery it is a common misconception that only a decrease in weight is a formidable way to combat and even "cure" T2D. Although weight loss allows for T2D to be more manageable, the ADA (American Diabetes Assoc.) as well as Dr. Blandine Laferrere feel a more complex process is at work (3).
Findings from other sources conclude the significant decrease in typical blood tests (HgbA1C, fasting plasma glucose and serum insulin) associated with T2D, post gastric bypass surgery. It is well documented that a change in ones lifestyle to include a more nutritious diet, regular exercise, and a less sedentary lifestyle can result in a decrease in weight, thus resulting in better health. Paul O'Brien et.al. suggest the use of Lap-Band surgery can assist patients to achieve the goals of a healthy life. Furthermore, O'Brien's findings suggest the weight loss can improve several aspects of one's health to include diabetes, asthma, dyslipidemia, hypertension, sleep, and reflux (4). More research offers explanations to how gastric bypass surgery, which is obviously associated with a marked weight loss, leads to a reduction in insulin resistance and indices of chronic inflammation (5).
Despite all these remarkable findings, the ADA (American Diabetes Association) stands by the gold standard of T2D prevention to being a healthy diet with moderate exercise. Therefore, do such findings from surgery "curing" diabetes offer a misleading solution to T2D? In a sense, is it possible that these findings will lead the general public to continue to have a "westernized" sedentary lifestyle? Thus leading to the conclusion or mindset of, "I can always have a quick fix surgery if my obesity and diabetes gets too out of control."Cures, however the form, are a wonderful thing but at what point does preventative medicine take a backseat to the quick fix? A quick fix where there is little known of the long-term effects.
1. Pories W, MacDonald K, et.al. (1992) Is Type II Diabetes Mellitus (NIDDM) a Surgical Disease? Annals of Surgery
2. http://asmbs.org/benefits-of-bariatric-surgery/
3. http://www.diabetes.org/news-research/research/research-discoveries/recent-advances/changes-in-amino-acid-levels.html
4. O'Brien P, Dixon J, et.al. (2002) The Laparoscopic Adjustable Gastric Band (Lap-Band): A Prospective Study of Medium-Term Effects on Weight, Health and Quality of Life. Obesity Surgery
5. Monte S, Caruana J, et.al. (2012) Reduction in endotoxemia, oxidative and inflammatory stress, and insulin resistance after Roux-en-Y gastric bypass surgery in patients with morbid obesity and type 2 diabetes mellitus. Surgery
This is definitely an interesting area of research. I agree with you completely that presenting this data as the researchers do, suggests that diabetic patients need not change their lifestyle in order to manage their condition.
ReplyDeleteI personally believe that lifestyle changes are the healthiest way to change any aspect of one's health. For example, surgery, weight loss pills, or fad diets, may initially work very quickly to cause someone to lose weight. However, this weight loss is not necessarily maintainable, because that particular person did not learn about the benefits of a healthy diet and exercise to control their body weight. I also believe that losing a large amount of weight quickly (from surgery or fad diets) is actually a huge shock to the body. I feel that it would be more beneficial to lose a smaller amount of weight per week, over a longer period of time.
I would like to see research where they compare two groups of T2D patients. Those who have had gastric bypass or lap band surgery, and those who have lost an equal amount of weight by changing their diet and exercising. A study like this may give more conclusive evidence as to why T2D can go into remission quickly with weight loss.
I thought that was interesting however, there are also some people who are not overweight but still have diabetes that I know personally. So I think it will help some people where the biggest reason for their high glucose levels are because of overeating and increased insulin sensitivity but not everyone because there must be something else deeper that is causing the overall issue.
ReplyDeleteDiana B. has a great point in saying that researchers, here, are telling people that they can quickly "fix" their obesity.
ReplyDeleteIn my opinion, using surgery as a means of "curing" T2D is not logical. Not only does surgically removing fat not teach people the importance of changing eating and exercise habits in order to maintain a healthy body, but it also teaches people that money can solve everything. People who undergo surgery in order to "cure" their obesity and/or T2D are willing to sacrifice their money and their time to do the surgery. However, even after the surgery, they must be able to maintain a healthy lifestyle to not gain back the weight that they used the surgery to lose. If that's the case, why couldn't they have just changed their lifestyle before the surgery? To me, it is the easier and more practical option. It may take a little longer for an obese person with T2D to lose weight just by eating and living healthier, but they would not have to spend all that money and time on getting surgery when changing lifestyle habits is something that they will have to do anyway.
I agree with you in theory, however in practice I imagine it's more difficult than it sounds. Not everyone, especially those who've fallen victim to obesity and/or T2D (regardless of the cause), finds it all that easy - for various reasons. One such reason worth addressing is one's SES. It may seem cheaper and more practical but purchasing foods that are healthy for oneself (and their family) is by no means a cheap endeavor. In some cases, I imagine, if someone has healthcare coverage and a family to support, the cheaper option may indeed be surgery where a portion is covered by insurance. Whether such a person changes his/her ways to have a healthier lifestyle is a different conversation altogether. All in all, it is a difficult topic of discussion.
DeleteI also agree with most people on here that healthy diet and exercise is the best way to go about this issue and avoid the surgery option. Looking from the people who has the T2D with obesity, I can understand their feelings that they don’t want to be in that state and eating healthy and exercise is a too big of change for them. Eating healthy is hard especially for someone who never really eats anything healthy in general and some the patient’s perspective exercise doesn’t seems to work (the instant cure thought) since it gradually shows result over time, so I can see why they would do this Gastric-Bypass Surgery for immediate hope of curing themselves of such disease/ obesity overall.
ReplyDelete