Surgical treatment of obesity and its effect on diabetes: 10-y follow-up

Abstract

Since 1980 we have performed the identical Greenville gastric bypass (GGB) procedure on 479 morbidly obese patients with an acceptable morbidity and a mortality rate of 1.2%. The weight loss in the series was well maintained over the follow-up period of 10 y. The GGB can control non-insulin-dependent diabetes mellitus (NIDDM) in most patients. The group of 479 patients included 101 (21%) with NIDDM and another 62 (13%) who were glucose impaired. Of these 163 individuals, 141 reverted to normal and only 22 (5%) remained with inadequate control of their carbohydrate metabolism. Those patients who were older or whose diabetes was of longer duration were less likely to revert to normal values. The gastric bypass operation is an effective approach for the treatment of morbid obesity. Along with its control of weight, the operation also controls the hyperglycemia, hyperinsulinemia, and insulin resistance of the majority of patients with either glucose impairment or frank NIDDM.

Evidence-based medicine reports on obesity surgery: a critique

“…Other than improvement in quality of life years (QALY), Clegg et al 4 only included an econometric analysis of the effect of weight loss surgery on the reduction in cost of medications required for treating type 2 diabetes mellitus (T2DM), while omitting many other comorbidities from their analysis ( Table 2). Even so, the authors excluded many studies of T2DM, not including one of several sequential series published by Pories and his colleagues, 45,48,6,49 confirming the efficacy of obesity surgery for this comorbidity. One of those studies demonstrated a mortality difference between operated and unoperated patients, in favor of operation.…”

“…However, they excluded several large studies demonstrating percent excess weight loss of approximately 60% at 5 y 39,45,95 and 50% at 10 y. 45 Hayes report. The Hayes report states that: 'There is evidence of a significant and sustained benefit of bariatric surgery for patients with disorders of glucose metabolism, such as diabetesyThere is less evidence that bariatric surgery leads to a sustained improvement in other conditions, such as hypertension and adverse lipid profiles'.…”

Gastroplastia como tratamento do diabete melito tipo 2

“…One of the first large series of operations in diabetic patients was the study of Greenville (USA), in which 165 diabetic patients were treated by gastric bypass and 83% of them remained in remission in 14 years of follow-up 24 .…”

A gastroplastia em manga (sleeve gastrectomy) e o diabetes mellitus

“…Para o tratamento cirúrgico da obesidade mórbida em associação com o T2DM várias técnicas têm sido empregadas, entre os quais a mais frequente é a gastroplastia de Fobi-Capella, que já apresenta grandes casuísticas 11 .…”

“…Uma das primeiras grandes séries de estudo de operações em diabéticos é o estudo de Greenville (EUA), no qual 165 pacientes diabéticos foram submetidos ao bypass gástrico e 83% destes permaneceram com remissão do diabetes em 14 anos de seguimento 11 . Um grande trabalho prospectivo e em andamento é o SOS (Swedish Obesity Subjects), que compara um grupo de pacientes operados com um outro não operado, que poderá esclarecer ainda alguns pontos.…”