Potential of Surgery for Curing Type 2 Diabetes Mellitus

Francesco Rubino, MD, Michel Gagner, MD, FACS, FRCSC

Disclosures

Annals of Surgery. 2002;236(5) 

In This Article

Surgery as a Cure for Type 2 Diabetes?

The evidence of this extraordinary control of diabetes by obesity surgery stimulates another intriguing question: since GBP and BPD seem to achieve control of diabetes as a primary, specific, and independent effect rather than secondary to the treatment of overweight, would these operations also be effective in moderately obese or in nonobese diabetics?

In 1997, Mingrone et al[52] reported a case of a young diabetic woman of normal weight who underwent BPD for chylomicronemia and whose plasma insulin and blood glucose levels were normalized within 3 months, even though she gained weight due to an unrestricted diet rich in sugar and lipids. Noya et al[53] reported remission of type 2 diabetes in 9 of 10 moderately obese (mean BMI 33.2) diabetic patients undergoing BPD.

Although some suggested that the etiology of type 2 diabetes mellitus might be different in obese patients because of the greater insulin resistance with respect to non-obese diabetic patients,[54] this finding was not confirmed by most studies.[55,56] It has been reported that the degree of insulin resistance is correlated with the degree of obesity only up to a BMI of about 30, after which there is little further change.[57] These observations suggest that GBP and BPD might achieve control of plasma glucose levels and insulin abnormalities at least in moderately obese patients (BMI > 30). Since more than 60% of patients with type 2 diabetes have a BMI above 28,[58] the potential is huge.

If morbid obesity surgery could become a specific treatment for type 2 diabetes, which operation should be performed? We believe that because of its low complication rate and lack of important late metabolic sequelae, GBP is more suitable than BPD for nonmorbidly obese diabetic patients. The fact that GPB is performed laparoscopically more often and in more centers is an additional advantage.

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