Introduction • As outlined in a released Diabetes Surgery Position Statement published in the Annals of Surgery issue, surgical approaches may well prove to be the treatment of choice in carefully selected patients with poorly controlled type 2 diabetes and a BMI greater than 30.
Obesity and Diabetes • While the authors of the Statement emphasize the need for more clinical trials to investigate the future role of surgery in diabetes treatment, they also call for further investigations on the mechanisms of surgical control of diabetes (which are far from being fully understood). • Although weight loss itself clearly plays a significant role in the reversal of diabetes generally seen with bariatric surgery, with gastric bypass surgery, this reversal of diabetes often precedes the weight loss and there are likely neuroendocrine consequences to allowing food to bypass the duodenum that may substantially affect glucose metabolism (including regeneration of pancreatic beta-cells).
Effects of Surgery • Thus, a better understanding of exactly how gastrointestinal surgery “cures” diabetes will hopefully also open new avenues for pharmacological treatments that can mimic the effects of surgery in these patients. • Indeed, certain gut-hormones, which are known to be dramatically affected by gastric bypass surgery (e.g. GLP-1), have already been shown to have a beneficial effect both on diabetes and weight management (e.g. liraglutide).
Tell Us Dr. Sharma will appreciate hearing from readers on their thoughts regarding whether or not diabetes surgery (vs. lifelong medications or injections) will significantly change how we treat diabetes in the future.
About Dr. Arya M. Sharma Dr. Arya M. Sharma, MD/PhD, FRCPC is Professor of Medicine & Chair for Obesity Research and Management at the University of Alberta, Edmonton, Canada. He is also the Medical Director of the Edmonton Capital Health Region’s interdisciplinary Weight Wise Program. Dr. Sharma is also the Scientific Director of the Canadian Obesity Network funded through the federal Networks of Centres Excellence program. Dr. Sharma has authored and co-authored more than 250 scientific articles and has lectured widely on the etiology and management of obesity and related cardiovascular disorders. He sends his informative messages through his blog Dr. Sharma’s Obesity Notes. For more information on Obesity visit; Website: http://www.drsharma.ca/ Facebook: http://www.facebook.com/pages/Dr-Arya-Sharma/115328778486319