Type II diabetes had become a major
epidemic in the United States with about 1.4 million people being diagnosed
every year. The cost of this disease, including the medications needed to
maintain the symptoms and the serious complications that can arise, has cost
the United States $245 billion dollars (Daousi, et.al. 2006). Type II diabetes
is defined as an insensitivity to insulin, which prevents the body from up
taking glucose, the cells main source of energy. Usually patients with Type II
diabetes are left taking many medications to regulate their glucose levels and
to treat the symptoms, but are left with little hope for a cure, until now.
In a recent study, done by Albers
and his team, shows a significant correlation between patients who undergo
Roux-en-Y surgery and a reversal of Type II diabetes. Roux-en-Y is a type of
gastric bypass surgery that is used in obese patients to aid in weight loss. In
this surgery, the jejunum of the small intestines is connected to the end of
the esophagus, which allows deglutinated food to bypass the stomach. A unique
feature of this weight loss surgery is that the stomach is left intact and is
connected back to the small intestines, which still allows the gastric enzymes,
like pepsin, and pancreatic bile to be released jejunum of the small intestines
to aid in digestion (Albers, et. al. 2016).
The study has found that 80% of
patients who underwent the Roux-en-Y surgery showed signs of increased insulin
sensitivity in just 3 months and of those patients 72% of them showed no signs
of having Type II diabetes by 12 months post-op. The mechanism of how this
surgery causes the insulin sensitivity to be regain is unknown. They
hypothesize that adipose tissue might have a larger direct effect than
previously thought, but more research is needed (Albers, et. al. 2016).
One of the ethical considerations
of this finding is whether the reversal of Type II diabetes will outweigh the
long-term effects of the Roux-en-Y surgery. In any gastric bypass surgery, the risk
of malnutrition becomes a genuine concern. Patients who have the surgery are
unable to digest and absorb the nutrients that they need and so they must be
supplemented and carefully monitored. For obese patients, the Roux-en-Y surgery
gives them a chance to have a happy and healthier life, which includes the
remission of Type II diabetes. But for some patients’ surgery’s side effects
will not outweigh the benefits and this will cause the physicians practice
beneficence to make judgment calls on whether the Roux-en-Y surgery will not
harm the patients more then it will help.
Daousi, C., Casson, I. F.,
Gill, G. V., MacFarlane, I. A., Wilding, J. P. H., & Pinkney, J. H. (2006).
Prevalence of obesity in type 2 diabetes in secondary care: association with
cardiovascular risk factors. Postgraduate Medical Journal, 82(966),
280–284. http://doi.org/10.1136/pmj.2005.039032
P H. Albers, K N. Bojsen-Møller, C Dirksen, A
K.Serup, D E. Kristensen, J Frystyk, T R. Clausen.
American Physiological Society (APS). "Gastric bypass surgery improves
blood sugar handling and insulin sensitivity, study finds." ScienceDaily.
ScienceDaily, 5 October 2016. <www.sciencedaily.com/releases/2015/10/151005082602.htm>.
It would be fantastic if eventually the surgery benefits outweighed the costs! As of right now, I am not sure if they do. For patients with type 2 diabetes, they are constantly managing their diet to keep their blood sugar under control. They are told to eat healthy, preferably a lot of small meals and to exercise regularly. They also might take drugs like metformin to lower the production of glucose. If a patient had the Roux-en-Y surgery, they are required to be on a liquid diet for so long but then are told the exact same thing that the patient with diabetes type 2 is told. They need to manage their diet and exercise frequently to stay healthy. I helped out with the bariatric seminars where I worked before this program and the biggest concept they wanted everyone to understand was that the weight loss was up to them after the surgery. Their diet had to drastically change and if it didn't they would end up back where they started.
ReplyDeleteI think that the surgery needs to offer something more before it should be considered the cure! As always, more research needs to be done but it definitely looks promising!
https://www.obesitycoverage.com/the-big-gastric-bypass-diet-guide/