Type 1 diabetes is not associated with increased central abdominal obesity

Surgical approaches to the treatment of obesity: bariatric surgery

As the obesity epidemic continues to grow in the Unites States, so does the search for the ideal nonsurgical or surgical solution. Bariatric surgery continues to be the most sustainable form of weight loss available to morbidly obese patients. In addition, bariatric surgery has established an acceptable safety profile with respect to morbidity and mortality. With the number of elective bariatric cases growing in recent years, it is unsurprising that results have improved and better data are emerging regarding improvement of obesity-related comorbid conditions. Additionally, ample evidence suggests that bariatric surgery may increase longevity, particularly through reducing cardiovascular deaths. Although the specific mechanisms involved in the remission of these medical conditions remain to be fully elucidated, it has become clear that bariatric surgery has established a significant and firm role in the treatment of medical comorbidities that result directly from obesity. However, until commercial insurance carriers provide improved coverage for bariatric surgery, patient access to these treatments will remain limited.

Surgical approaches to the treatment of obesity: bariatric surgery

As bariatric surgery for the treatment of morbid obesity enters its sixth decade, much has been and continues to be learned from the results of several key bariatric operations, particularly the Roux-en-Y gastric bypass. Because of the obesity epidemic and development of the laparoscopic approach, bariatric procedures have increased exponentially in the past decade and are now among the more commonly performed gastrointestinal operations. Emerging data support the role of bariatric surgery as an effective treatment for improvement or remission of type 2 diabetes, hypertension, dyslipidemia, and multiple other comorbid conditions that accompany obesity. The mechanisms involved in the remission of these conditions, however, remain poorly understood and constitute an exciting area of research. This article delineates the current types of bariatric surgery, their respective outcomes, and their impact on obesity-related medical comorbidities.

Remission of Diabetes after Laparoscopic Gastric Bypass

Diabetes is a well-recognized and treatable risk factor for cardiac disease, and one of many comorbidities associated with obesity. The aim of this study was to evaluate the clinical outcome of a cohort of morbidly obese patients with documented diabetes who underwent laparoscopic Roux-en-Y gastric bypass. Fifty-nine patients with sufficient follow-up were included in the study. Mean preoperative duration of diabetes was 68 months. At 1 month postoperatively, mean excess body weight loss was 17 per cent with 29 patients (49%) showing improvement and 21 patients (36%) having remission of their disease. Mean excess body weight loss was 67 per cent at 12 months postoperatively with 25 patients (42%) showing improvement and 34 patients (58%) having remission of diabetes. Mean preoperative fasting blood glucose level decreased from 152 g/dL preoperatively to 100 g/dL at 12 months (P = 0.02), whereas glycosylated hemoglobin decreased from 7.9 per cent to 5.7 per cent, respectively (P < 0.01). Patients with remission of diabetes had a shorter length of condition compared with patients with only improvement (43 vs 103 months, P < 0.01). Weight loss associated with laparoscopic gastric bypass significantly improves diabetes control and results in discontinuation or marked reduction of antidiabetic medications in the majority of patients. Improvement in glucose control occurs as early as 1 month postoperatively.