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The incidence of type 2 Diabetes Mellitus is rising. It presently affects more than 150 million people worldwide, and 7.5% of the general population of Europe suffer from this disease. This is explained partially by an increase in the prevalence of obesity. Less than 10% of the diabetic patients achieve appropriate control of their illness.
This is already over 10 years that the resolution of type 2 diabetes has been observed as an additional outcome of surgical treatment of morbid obesity. Moreover, it has been shown unequivocally that diabetes–related morbidity and mortality have declined significantly postoperatively. This improvement in diabetes control is long lasting, and was well documented for as long as 16 years postoperatively.
Two procedures, the Roux-en-Y gastric bypass (RYGBP) and the Biliopancreatic Diversion (BPD), are more effective treatments for diabetes than other procedures and are followed by normalization of concentrations of plasma glucose, insulin, and glycosylated hemoglobin in 80–100% of morbidly obese patients. Studies have shown that return to euglycemia and normal insulin levels occur within days after surgery, long before any significant weight loss occurs. This fact suggests that weight loss alone is not a sufficient explanation for this improvement. Other possible mechanisms effective in this phenomenon are decreased food intake, partial malabsorption of nutrients, and anatomical alteration of the gastrointestinal tract, that incites changes in the incretin system, which in turn, affect glucose balance. Better understanding of those mechanisms may bring about a discovery of new treatment modalities for Diabetes and obesity.
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