Photo by M Clock |
One of the benefits of being a fresh empty-nester is the newfound ability to travel more, and taking advantage of 'non-committed' time. We never had the time in the past to even contemplate such a thing, but now our two active boys are in college. So, it did happen, and it's actually quite OK. It just seems now to have come on us kind of quick.
The other aspect of a little more free time is to be able to stop and smell the roses a little more, hence this photo of a beautiful Central NY sunset, as seen in the rear view mirror while driving this past weekend.
So, now time for part 2 on the mechanisms of the physio-metabolic benefit of bariatric surgery. Here's the way to potentially put your patient's DM2 in the rearview mirror, and maybe even a distant memory if all goes well.
To start off, as you may have seen, 2 landmark studies were recently published in NEJM that definitely showed the powerful effects of Bariatric Surgery on Diabetes.
Here's the deal. Cutting the stomach, whether to create a pouch as in a Gastric Bypass, or creating a narrow linear portion of stomach left behind as in a Sleeve Gastrectomy, causes significant changes in gut hormone secretion that greatly encourage euglycemia from many different angles. There does seem to be a slight difference between the Sleeve and the Bypass as far as Diabetes benefit goes, mostly owing to duodenal exclusion with the Bypass, but both do have substantial anti-Diabetic effects.
While this is an area of new and evolving discovery, here's a quick look at what we do know:
*Bypass of the Foregut impairs ghrelin secretion, which causes generally decreased hunger, and quicker satiation.
*Stimulated secretion of Peptide YY (PYY), which also increases satiation and impairs gastric emptying, and a delayed effect of elevation in post prandial bood sugar.
*Stimulated secretion of Glucagon-like Peptide-1 (GLP-1), which causes a classic incretin effect of stimulated insulin secretion via unburdened and enhanced pancreatic Beta cell function. Also, further inhibits gastric emptying and decreased food intake.
Surely there will be much more to come on these and further gut hormone discoveries when they happen. They are being longitudinally studied. as we speak, in a bariatric surgery registry that is an ongoing account of the effects of weight loss surgery on such markers as Diabetes. The implications for the pharmaceutical industry for a similar medical trigger, in pill form, and for the more than 8.3% of the US population with Diabetes type 2 (25.8 million people) will likely be game-changing.
But for now, the only place for one-stop metabolic shopping for Diabetes benefit that is this rapid and clear cut, is in the surgical subspecialty of Bariatric Surgery (pun intended).
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