The following are the most common bariatric surgeries performed in the United States and their known effects on T2DM.
ROUX-EN-Y GASTRIC BYPASS
Roux-en-y Gastric Bypass is a surgery that alters the GI tract to cause food to bypass most of the stomach and the upper portion of the small intestine. The operation results in significant weight-loss and causes remission of T2DM in 80 percent of patients and improvement of the disease in an additional 15 percent of patients.
Improvement or remission of diabetes with gastric bypass occurs early after surgery and before there is significant weight-loss. The weight-loss independent mechanisms of diabetes improvement after gastric bypass are partially explained by changes in hormones produced by the gut after the surgery, and this is an active area of research in the field of metabolic and bariatric surgery.
Sleeve Gastrectomy (Vertical gastrectomy) is an operation that removes a large portion of the stomach and, in doing so, causes weight-loss. The remaining stomach is narrow and provides a much smaller reservoir for food.
Sleeve gastrectomy also appears to have some weight-loss independent effects on glucose metabolism and also causes some changes in gut hormones that favor improvement in diabetes. Diabetes remission rates after sleeve gastrectomy are also very high (more than 60%) and, in some studies, similar to results seen after gastric bypass.
ADJUSTABLE GASTRIC BAND
The Adjustable Gastric Band is a weight-loss procedure that involves the placement of a band around the upper portion of the stomach.
Remission of diabetes occurs in approximately 45-60 percent of patients. The remission or improvement of diabetes, however, is secondary to the weight-loss produced by the procedure, and there does not appear to be any other mechanism for diabetes improvement in band patients. In other words, patients who have diabetes and who are unsuccessful in losing weight with the AGB will unlikely see any improvement in the diabetes.
The Duodenal Switch is a malabsorptive procedure performed far less frequently than the gastric bypass, sleeve gastrectomy or the adjustable gastric band due to the complexity of the procedure and the greater risk of complications. Studies find, however, that the operation is most effective in inducing early and sustained remission or improvement of T2DM (more than 85 percent remission rates with weight-loss independent effects)
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