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Diabesity : A Literature Review. By: Courtney Saia. Purpose Statement:. To determine whether Bariatric surgery is effective at eradicating Type 2 Diabetes Mellitus (T2DM). Diabetes:. T2DM affects more than 170 million people worldwide.

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Diabesity a literature review

Diabesity: A Literature Review

By: Courtney Saia

Purpose statement
Purpose Statement:

  • To determine whether Bariatric surgery is effective at eradicating Type 2 Diabetes Mellitus (T2DM).


  • T2DM affects more than 170 million people worldwide.

  • Limited success has been reached in the treatment of diabetes.

  • Estimated that the number of individuals living with diabetes will increase to 365 million worldwide by 2030.

  • People with Diabetes are more likely to have: cardiovascular, renal and ophthalmic comorbidities.


  • World Health Organization (WHO) estimates more than 1.6 billion people are overweight, 400 million are obese.

  • More than 77 million American adults are obese.

  • The literature suggests diet and exercise combined along with weight reduction medications does not result in durable weight loss for obesity.


  • Due to the substantial link between T2DM and obesity the coining of the word Diabesity has been prompted.

Bariatric surgery
Bariatric Surgery:

  • Typically results in sustained weight loss and durable glycemic control.

  • A surgery performed on the stomach and/or intestines in an effort to help an individual with obesity lose weight.

  • Four types of procedures:

    • Laparoscopic Adjustable Gastric Banding (LAGB)

    • Biliopancreatic Diversion with Duodenal Switch (BPD-DS)

    • Sleeve Gastrectomy (SG)

    • Roux-en-Y Gastric Bypass (RYGB)

Bariatric surgery appropriateness criteria
Bariatric Surgery: Appropriateness Criteria

  • Age:

    • Male: ≥ 45 years

    • Female: ≥ 55 years

  • BMI: ≥ 35

  • Severity of obesity-related comorbidities:

    • Established coronary heart disease

    • Other atherosclerotic diseases

    • T2DM

    • Sleep apnea

    • Stroke

    • Cancer

    • Osteoarthritis

    • Gallstones

    • Stress incontinence

    • Gynecological abnormalities

Laparoscopic adjustable gastric banding lagb
Laparoscopic Adjustable Gastric Banding (LAGB):

  • Restrictive Operation

  • Rigid, plastic band with a saline filled rubber, balloon lining is used.

  • Band is placed around the upper section of the stomach (below the gastroesophageal junction).

  • Flexible tubing is connected from the band to a port on the outside of the body.

    • Port allows for the surgeon to adjust the saline content of the band by a hypodermic needle.

Sleeve gastrectomy sg
Sleeve Gastrectomy (SG):

  • Restrictive Operation.

  • 10-14 mm is placed along the right side of the stomach.

  • Surgical stapler is fired adjacent to the tube until the left side of the stomach is completely restricted  banana-shaped stomach (holds ≈ 150-200 mL)

  • Decreases ghrelin levels.

Sleeve gastrectomy sg1
Sleeve Gastrectomy (SG):

Biliopancreatic diversion with duodenal switch bpd ds
Biliopancreatic Diversion with Duodenal Switch (BPD-DS):

  • Restrictive and Malabsorptive Operation

  • Sleeve Gastrectomy (SG) provides the restriction.

    • Large portion of the small intestine is bypassed  150-200 cc gastric sleeve which is connected to the remainder of the small intestine

  • Excluded portion of the small intestine is attached 100 cm to the ileocecal valve.

    • Serves as the conduit for bile and pancreatic juices

Biliopancreatic diversion with duodenal switch bpd ds1
Biliopancreatic Diversion with Duodenal Switch (BPD-DS):

Roux en y gastric bypass rygb
Roux-en-Y Gastric Bypass (RYGB):

  • Primarily performed laparoscopicaly through 5-7 trocar sites.

  • Surgical stapler creates a small, stomach pouch.

    • Containing only food particles.

  • Bowel beyond the stomach pouch contains both food particles and digestive juices.


  • The following databases were used:

    • CINAHL, Web of Knowledge, Medline, Google Scholar

  • The terms “bariatric surgery” and “diabetes treatment” were entered.

  • To limit the search Boolean logical operators, source type, date of publication, language, study participants, and the truncation of terms were used.

  • A total of 27 articles were referenced

Resolution of diabetes after lagb
Resolution of Diabetes after LAGB:

  • Dixon et al.

    • 50 participants with T2DM, followed for 1 year post-operative

    • Remission of T2DM was defined as (normal HbA1c levels, without pharmaceutical therapy).

    • Results:

      • 64% of participants achieved T2DM remission

      • 26% noted improvement in glycemic control

      • 10% remained unchanged

Resolution of diabetes after lagb1
Resolution of Diabetes after LAGB:

  • Dixon: Later Study

    • Randomized-controlled study

    • Intervention:

      • LAGB (experimental group) or diet and exercise (control group)

    • Results:

      • 73% of participants who received LAGB demonstrated T2DM remission.

      • 13 % of the participants in the control group demonstrated T2DM remission.

Resolution of diabetes after lagb2
Resolution of Diabetes after LAGB:

  • Ponce et al.

    • 402 LAGB patients were reviewed.

    • Preoperatively 53 out of the 402 patients were on hypoglycemic medication for T2DM

    • Results:

      • T2DM resolution in 66% of patients at the 1 year mark

      • T2DM resolution in 80% of patients at the 2 year mark

Resolution of diabetes after bpd ds
Resolution of Diabetes after BPD-DS:

  • Scopinario

    • Looked at 2,241 BPD patients and determine 100% of those of T2DM had resolution (4 months postoperative)

  • Scopinario: 2008 Study

    • Comparison of RYGB and BPD.

    • Data from 443 patients with T2DM between the years of 1976 and 2007 were collected

    • Results:

      • 75% of patients were in remission 2 months postoperative.

        • Remained stable for almost a 20 year period

Resolution of diabetes after sg
Resolution of Diabetes after SG:

  • University of Pittsburgh (2006):

    • 126 patients

    • Results:

      • 1 year postoperative, 81% of SG patients demonstrated T2DM resolution; 10% showed significant improvement.

  • Italian Study:

    • 44 SG patients

    • Results:

      • 76% of participants showed T2DM resolution during 19 year follow up

      • T2DM improvement was reported in 15% of patients

Resolution of diabetes after rygb
Resolution of Diabetes after RYGB:

  • Pories

    • 608 RYGB patients (121 had T2DM and 150 had impaired glucose tolerance)

    • Patients were followed for 14 years postoperatively.

    • Results:

      • 83% of the 121 T2DM patients experienced resolution.

      • 98% of the 150 with impaired glucose tolerance maintained normal levels.

Resolution of diabetes after rygb1
Resolution of Diabetes after RYGB:

  • Swedish Obese Subjects Study Group:

    • 2004 report included 4,047 postoperative subjects followed for 2 years and 1,703 for 10 years.

    • Results:

      • T2DM recovery was reported in 72% of RYGB patients compared to 21% resolution in the medical management group.


  • Many of the studies were uncontrolled case studies with a few being randomized controlled trails.

Possible theories of resolution
Possible Theories of Resolution:

  • While the results of the studies were statistically significant, the pathophysiology of the T2DM resolution is not understood.

  • Combination of weight loss, decreased caloric intake, intestinal malabsorption, hormonal changes, and rearrangement of the gastrointestinal anatomy

Effect of bariatric surgery on t2dm
Effect of Bariatric Surgery on T2DM:

  • All bariatric surgical procedures induce decreased caloric intake, which has a well established beneficial effect on T2DM.

  • Glucose homeostasis improves more rapidly after segments of the small bowel are bypassed when compared to restrictive procedures

Most intriguing fact
Most Intriguing Fact:

  • Weight loss does not appear to be the primary mechanism for T2DM resolution after RYGB and BPD-DS.

    • Most studies noted T2DM resolution occurs within days after surgery before any significant weight loss has occurred.

Further research
Further Research:

  • Randomized clinical trials comparing surgical and medical therapies for T2DM are needed.

    • Due to increasing numbers of diabetes patients undergoing bariatric surgery.

  • Bariatric surgical procedures should be incorporated into a national clinical registry.

    • Enable objective assessments of the risk and benefits.