IS BARIATRIC SURGERY AN EFFECTIVE

TREATMENT FOR DIABESITY?

Caitlin McGrath and Paul Schubert

Lock Haven University of Pennsylvania

2012

Background

Growing Problem 140% increase in Obesity (7) Concomitant growth

9.3%

Background Continued

Diet and ExerciseImportant and worksRarely durable (1)

Current Standards of TreatmentSensitizers (Metformin, Pio/Rosiglitizone)Insulin secretagogues (Glipizide)Insulin Injections (Humolog, Lantus)

ExpensiveRequires increased amounts of medication as

time goes on (1)

Background Continued

BARIATRIC SURGERY

Methods

Literature ReviewEffectiveness of methodsPower of their results

Results

Range of ResultsLap-Gastric Band – 48%Biliopancreatic Diversion with Duodenal

Switch – 98%70-95% with other methods

Discussion - Effectiveness Viable Option

Effectively resolves diabetesCosmeticCost effective

PaymentOut of pocketHTN medications

Surgical Complications

Discussion - Physiology

Days to weeks Theories

StarvationGrehlinGLP-1Unknown

Disscussion – Starvation

Most obvious Decreased caloric intake

Disscussion – Ghrelin

Makes you hungry Low levels post bariatric surgery

Possible reason for diabetes resolution

Disscussion – GLP-1

Multiple effectsIncreases insulin release in response to

hyperglycemiaDecreases pancreatic beta cell apoptosis

Increased after bariatric surgery

Disscussion – Which surgery?

Gastric Banding vs More invasive Complications

Discussion – Oral Medications

Miracle Cure? Oral Medications Fewer diabetes complications

Conclusion

Must have a change Don’t have oral medications yet Bariatric Surgery is the best we have

References 1. Arroyo, K., Kini, S.U., Harvey, J.E., Herron, D.M. (2010). Surgical therapy for diabesity. Mount Sinai

Journal of Medicine 77(5), 418-430.  2. Buchwald, H., Estok, R., Fahrbach, K., Banel, D., Jensen, M.D., Pories, W.J., Bantle, J.P., Sledge, I.

(2009).  Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis.  The American Journal of Medicine, 122 (3), 248-256.

3. Buchwald, H., Avidor, Y., Braunwald, E., Jensen, M.D., Pories, W., Fahrbach, K., Schoelles, K. (2004). Bariatric surgery: a systematic review and meta-analysis. The journal of the American medical association 293(14), 1728.

4. Cremieux, P.Y., Ghosh, A., Yang, H.E., Buessing, M., Buchwald, H., Shikora, S.A. (2008). Return on investment for bariatric surgery. American journal of managed care 14(11), 5-6.

 5. Cummings, D. (2009). Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery. International Journal Of Obesity (2005), 33 Suppl 1S33-S40.

 6. Gan, S., Talbot, M., & Jorgensen, J. (2007). Efficacy of surgery in the management of obesity-related type 2 diabetes mellitus. ANZ Journal Of Surgery, 77(11), 958-962.

7. Lin, E., Davis, S., Srinivasin, J., Sweeney, J., Ziegler, T., Phillips, L., Gletsu-Miller, N. (2009). Dual Mechanism for Type-2 Diabetes Resolution after Roux-en-Y Gastric Bypass. The American Surgeon, 75(6), 498-503.

 8. Mingrone, G., & Castagneto, M. (2009). Bariatric surgery: unstressing or boosting the beta-cell?. Diabetes, Obesity & Metabolism, 11 Suppl 4130-142.

 9. Villamizar, N., Pryor, A.D. (2011).  Safety, effectiveness, and cost effectiveness of metabolic surgery in the treatment of type 2 diabetes mellitus.  Journal of Obesity, 2011, 1-6.