20,000 postop followed for upto 13 yrs
Below is a chart outlining the differences following weight loss surgery in the cure and or reduction of diabetes and other serious morbid obesity related diseases reported by Harvey Buchwald, M.D. in his meta analysis published in 2004. In this study over 20,000 postoperative bariatric patients were followed for up to 13 years.
Obesity Related Illnesses that Improved/Resolved Following Weight Loss Surgery:
| Gastric Band | RNY | DS | |
| Diabetes Mellitus | 47.9% | 83.7% | 98.9% |
| Hyperlipidemia | 58.9% | 96.9% | 99.1% |
| Hypertension | 43.2% | 67.5% | 83.4% |
| Sleep Apnea | 95% | 80.4% | 92% |
From Page 7
Cormorbidity Outcomes Diabetes. When defined as the ability to discontinue all diabetes-related medications and maintain blood glucose levels within the normal range, strong evidence for improvement in type 2 diabetes and impaired glucose tolerance was found across all surgery types. Within studies reporting resolution of diabetes, 1417 (76.8% [meta-analytic mean, 76.8%; 95% CI, 70.7%-82.9%]) of 1846 patients experienced complete resolution. Within studies reporting both resolution and improvement or only improvement of diabetes, 414 (85.4% [meta-analytic mean, 86.0%;95% CI, 78.4%-93.7%]) of 485 (mean change, 71.53 mg/dL; 95% CI, 49.37%-93.69 mg/dL [3.97 mmol/L; 95% CI, 2.74-5.2 mmol/L]; n=296 by meta-analysis) compared with unselected populations (means change, 13.33 mg/dL; 95% CI, 10.81-15.86 mg/dL [0.74 mmol/L; 95% CI, 0.60-0.88 mmol/L]; n-2092 by meta-analysis.
There was a difference in diabetes outcomes analyzed according to the 4 categories of operative procedures. With respect to diabetes resolution, there was a gradation of effect from 98.9% (95% CI, 96.8%-100%) for bioliopancreatic diversion or duodenal switch to 83.7% (95% CI, 77.3%-90.1%) for gastric bypass to 71.6% (95%CI; 55.1%-88.2%) for gastroplasty, and to 47.9 (95% CI, 29.1%-66.7%) for gastric banding. The percentage of patients with diabetes resolved or improved showed different results (Table 5 [page 9]); this variation from the trend solely for diabetes resolved may be due to the far greater number of patients assessed for this variable (n=85) in the total population.
From Page 10
Resolution of diabetes often occurred days following bariatric surgery, even before marked weight loss was achieved. Resolution of diabetes was more prevalent following the predominantly malabsorptive procedures (bioliopancreatic diversion or duodenal switch) and the mixed/restrictive gastric bypass in contrast to the purely restrictive gastroplasty and gastric banding procedures. In addition, there appeared to be a gradation of diabetes resolution as a function of the operative procedure itself. 98.9% for bioliopancreatic diversion or duodenal switch 83.7% for gastric bypass 71.6% for gastroplasty, and 47.9% for gastric banding.
The putative extent and time relationship of the different operative procedures to diabetes resolution or improvement after bariatric surgery may be related to some of the changes in the gut related hormones. The hormonal milieu, or the relative balance of forgut mediators, is differently affected when the distal stomach is bypass, or a partial gastrectomy is performed, and the enteric contents are separated from the bioliopancreatic stream in the upper small intestinal tract. The study of the impact of the various bariatric procedures on leptin, grehlin, resistin, acylation-stimulating protein, adiponectin, entro-glucagon, cholecystokin, and other gastrointestinal satiety mediators receiving increasing attention.
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