Every 10 seconds in the world, one person dies due to organ damage due to diabetes.
The incidence of diabetes among morbidly obese patients is over 25%.
Those with type 2 diabetes. The most effective treatment for obese individuals today is metabolic and bariatric surgery.
Approximately 80% of type 2 diabetic patients who undergo bariatric or metabolic surgery recover from the disease without using medication.
International Diabetes Federation (IDF) recommends bariatric surgery to patients with diabetes and a BMI >35, and to patients with a BMI of 30 -35 whose diabetes cannot be controlled with existing medications.
Post-operative recovery criteria in diabetic patients, in the 2-year period following the surgery:
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It is defined as fasting sugar falling below 126 mg/dl without medication
HbA1c level falling below 6.2% without medication.
Metabolic Syndrome
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Waist circumference being >102 cm in men and >88 cm in women
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Triglyceride level in the blood is 150 mg /dl or above
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LDL cholesterol being below 40 mg/dl in men and 50 mg/dl in women
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High blood pressure (>130/>85 mmHg)
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High blood sugar (>110 mg/dl)
Most of the above criteria A person who has at least 3 of them is considered to have metabolic syndrome.
Metabolic surgery gives better results in patients who have been diagnosed with diabetes for less than 5 years.
With good HbA1c levels before surgery. Metabolic surgery gives better results in diabetic patients.
Diabetic patients whose sugar is under control only with diet therapy get much better results from surgery than those who use medication.
Diabetic patients who are treated with pills, They get better results from metabolic surgeries than diabetic patients treated with insulin.
Surgery results are better in diabetic patients with a BMI>35.
They lose 60% or more of their excess weight (EWL- Results are better in diabetic patients (excess weight loss).
Surgical results are better in diabetic patients who are young and whose C-peptide level is >2.9 ng/ml.
Sugar h In terms of control of diabetes, the results are better in those who underwent gastric bypass than in those who underwent sleeve gastrectomy.
In gastric bypass surgery, relief from diabetes usually occurs before serious weight loss.
Improvement in sugar metabolism alone. cannot be explained by weight loss; because sugar metabolism recovers within days after metabolic surgery.
With weight loss, the amount of hormone (adiponectin) that increases insulin sensitivity and the number of insulin receptors increase.
When the amount of weight loss is taken equally, gastric bypass It has been observed that it regulates sugar metabolism better than calorie restriction and gastric band operations.
The intestines are the largest endocrine organ in our body. In addition to digestion, many hormones are secreted that regulate body weight and sugar metabolism.
Two hypotheses have been put forward to control diabetes after bariatric and metabolic surgery:
Hindgut Hypothesis: Since the nutrients will pass directly to the last part of the small intestine after the bypass, diabetes is controlled by stimulating the L cells here and through the hormones secreted.
Foregut Hypothesis: By surgically preventing the passage of food into the first part of the small intestine, the secretion of some hormones that cause insulin resistance is prevented.
Metabolic Surgery changes the levels of many hormones such as GLP-1 (glucagon like peptide-1), PYY (peptide-YY) and ghrelin, which are secreted from the intestinal system and regulate sugar metabolism.
GLP-1(glucagon like peptide). -1) hormone is secreted from L cells stimulated by food in the last part of the small intestines and large intestine.
GLP-1 (glucagon like peptide-1) hormone increases glucose-dependent insulin release, glucose tolerance and insulin sensitivity of cells. In addition, it reduces the release of glucagon (increases sugar) and the emptying of food from the stomach.
In patients undergoing gastric bypass, there is a significant increase in GLP-1 levels starting from the 2nd day of the operation. This indicates that the effect of gastric bypass surgery on diabetes is due to weight loss. shows that it is independent. Gastric band surgery There is no change in GLP-1 level during treatment.
With weight loss in diet treatment, GLP-1 levels do not increase and in fact GLP-1 levels tend to decrease. This paves the way for diabetes.
Ghrelin hormone is released especially from the stomach. It increases food intake by increasing the feeling of hunger. It reduces insulin release; It also paves the way for diabetes by suppressing the release of adiponectin, which increases sensitivity to the insulin hormone.
Ghrelin hormone level increases in patients trying to lose weight with diet. Therefore, the feeling of hunger increases and the groundwork for diabetes increases. Since the feeling of hunger increases, the diet becomes unsustainable after a certain point.
Serious decrease in ghrelin levels after gastric (stomach) bypass and sleeve gastrectomy (sleeve gastrectomy). Ghrelin level and response do not change in gastric band application.
PYY (peptidYY) hormone is secreted from the L cells of the intestine together with GLP-1. PYY hormone restricts food intake by reducing the feeling of hunger; It also corrects insulin resistance with a direct effect. PYY hormone increases after gastric bypass and sleeve gastrectomy surgeries.
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