Diabetes – Obesity & Bariatric Surgery

Diabetes – Obesity & Bariatric Surgery

How does Obesity lead to Type II Diabetes?

Obesity contributes to development of diabetes by causing insulin resistance and producing a state of chronic inflammation. The inflammatory state is produced by cytokines (type of hormone) produced by the excessive number of fat cells (adipose tissue) in Obese individuals present in muscles, abdomen and liver. These cytokines also contribute to excessive free fatty acids in the blood stream. The cytokines and free fatty acids in the blood stream contribute to this state of inflammation which are responsible for insulin resistance (IR). Once IR develops, Insulin is not allowed to work on all the tissues where it is supposed to work leading to high levels of blood sugar which manifests asType 2 Diabetes. Apart from T2 DM, this IR is also responsible for number of co morbidities seen in obese individuals.

Who would have known that Bariatric Surgery can cure Type 2 Diabetes in Obese people?

People would not have believed if in 1980’s somebody said that Type2 Diabetes can be cured with surgery, but that’s what is exactly happening now! Obesity is now deemed to be the leading cause for the increased incidence of Type 2 Diabetes in India and worldwide. It is well known that Type 2 diabetes mellitus (T2DM) is caused by increasing insulin resistance and progressive failure of beta cells in the pancreas which produce insulin.

How does Bariatric Surgery help?

Although the exact mechanism is not known, it is now very clear that having a Laparoscopic Roux En Y Gastric Bypass a form of Bariatric Surgery) can reverse Insulin Resistance virtually overnight. There is enough evidence in the literature that following this patient can develop a state of Remission from their Diabetes not requiring medication for Diabetes. Patients who are taking Insulin often do not need to take it in the long term particularly if their Beta Cell function of the pancreas is good.

With control of Diabetes the risk of disabling and life threatening complications of the disease is averted and this has prompted the International Diabetes Organization (IDO) to come out with a consensus statement last year cementing the place of Bariatric Surgery in the treatment algorithm of Diabetes Mellitus.