Is type II diabetes mellitus (NIDDM) a surgical disease?

Area of Science:

• Bariatric Surgery
• Metabolic Surgery
• Obesity Management

Background:

• Morbid obesity is a significant health concern associated with metabolic disorders like diabetes.
• The Greenville gastric bypass (GGB) is a surgical procedure aimed at weight reduction in severely obese individuals.
• The impact of GGB on glucose metabolism and diabetes control in obese patients requires further investigation.

Purpose of the Study:

• To evaluate the effectiveness of the Greenville gastric bypass (GGB) in managing morbid obesity and associated metabolic abnormalities, particularly diabetes.
• To assess the long-term weight control and glucose level normalization following GGB.
• To identify factors influencing the success of GGB in normalizing glucose metabolism.

Main Methods:

• Retrospective analysis of 515 morbidly obese patients who underwent the Greenville gastric bypass (GGB) from February 1, 1980.
• Assessment of pre- and post-operative glucose levels, glycosylated hemoglobin, and fasting insulin.
• Evaluation of weight loss and maintenance over an 11-year follow-up period.

Main Results:

• Out of 515 patients, 88.7% became euglycemic post-GGB, with only 5.8% remaining diabetic.
• Patients who did not achieve normal glucose values were older and had longer-duration diabetes.
• Significant weight loss was observed, with 89% no longer considered morbidly obese within 2 years, and sustained weight control over 11 years.
• Staple line breakdowns affected 9.5% of patients, contributing to weight regain.

Conclusions:

• The Greenville gastric bypass (GGB) is effective in controlling weight and improving glucose metabolism, including non-insulin-dependent diabetes, in severely obese patients.
• While GGB shows promise for managing diabetes in the obese, factors like patient age and diabetes duration influence outcomes.
• The procedure has a high rate of staple line failure, prompting a modification to a stomach-dividing technique.