Gastric bypass surgery may treat type 2 diabetes in selected patients.
Weight loss surgery has shown more effectiveness in patients with type 2 diabetes (T2D) who underwent gastric bypass surgery resulting in better insulin production in 6 months to a year without the need of further medication. This is rationalized due to dramatic weight loss and calorie cutting along after surgery. Thus, comprehending why gastric bypass is the most effective “metabolic surgery” to treat diabetes, why obese patients are noticeably less hungry post weight-loss surgery, and why improvement in diabetes after surgery may experience worsening within a matter of years are important considerations to account.
Several theories have been proposed to explain the causes of glycemic control post weight loss surgery. Some of the most common bariatric surgeries conducted are sleeve gastrectomy, Roux-en-Y gastric bypass, and gastric banding. The first two reduces the size of the stomach and the latter slows the flow of food into the GI tract. Although all three resolve T2D, gastric bypass has proven to be the most effective one. In the UK, an observational study showed that all participants who underwent gastric bypass, sleeve gastrectomy, and gastric banding were in remission at 43, 17, and 7 times higher respectively than no surgery. In comparison, gastric bypass yields more weight loss and effectiveness with nearly 2-fold higher remission rates than banding. Moreover, the National Institutes of Health-funded Longitudinal Assessment of Bariatric Surgery (LABS) study found 69% diabetes remission in obese patients in 3 years with Roux-en-Y gastric bypass versus 30% with laparoscopic gastric banding.
The compound effect of both caloric restriction and weight loss post surgery yields lower blood glucose and improves insulin sensitivity. Although results can be obtained without surgery within 10 to 20 days of caloric restriction, it is not feasible for obese patients for a prolonged period because surgery curbs appetite, increases satiety, and changes patients’ feeding behaviors. There is evidence that obese people are less sensitive to the pleasures of eating, resulting in compulsive eating. An experiment in rats on long-term food preferences post bariatric surgery showed that they no longer preferred highly concentrated sucrose, but the science behind the effects of microbiome on the brain is yet to be understood.
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