SURGERY TREATMENT FOR TYPE – 2 DIABETES

Type-2 diabetes is a chronic disease, which causes suffering in  many people of different ages, reducing years in quality of life, and therefore surgical treatment can be the solution to meet their expectations.
Nowadays, Type-2 diabetes is a world epidemic. In spite of technological advances, a satisfactory medical treatment has not been found that can revert the disease and prevent the evolution of complications caused by Type-2 diabetes.

This is a long-lasting disease. In spite of treatment, it continues to cause damage to different organs or systems that may go so far as causing the death of the patient before they reach their average life expectancy in any country of the world.

When weight-loss surgery started (particularly laparoscopic gastric by-pass), we started observing that patients with Type-2 diabetes, in addition to being obese, began recovering from their diabetes a few days after the surgery. Clinical studies began on this phenomenon and it was found that when food passed through the first part of the small intestine, substances called antiincreatins were produced. These inhibit the production of insulin and create resistance.

Another important fact was the discovery of a rise in substances called increatins which, when food passes through the end of the small intestine, produce an insulin increase and decrease resistance. This theory started the age of metabolic surgery. Nowadays, by means of metabolic surgery, the effect of type-2 diabetes can be reverted, avoiding complications and therefore increasing the patient’s life expectancy.  This surgery is not a new procedure; it was also done many years ago to treat gastric ulcers.

Some modifications have been done to the technique so that the patients will not lose weight and will not suffer any changes in their digestive process, obtaining the benefit of recovering from diabetes, the last important discovery that is helping many patients.

Currently, in some countries in Latin America, the procedure has been done for more than 5 years being 90 % effective in the cure of diabetes. In our Central American region, we are pioneers in this technique, with excellent results.

The following table contains the information on patients before and after surgery. The important discovery is that they do not need more treatment after the surgery.

Sr.	Age Gender	Time of diagnosis	Pre-Op Glycemia	12 months Glycemia
1	M 50 yo	1 y	110  15  lantus	156  No insulin
2	F 62 yo	12 y	122  60  nph	118  No insulin
3	F 57 yo	11 y	488  30/10  nph	173  No insulin
4	M 53 yo	10 y	323  No insulin	150  No insulin
5	M 62 yo	12 y	263  No insulin	165  No insulin
6	M 50 yo	2 y	235  No insulin	170  No insulin
7	F 53 yo	7 y	111  40  nph	167  No insulin
8	M 44 yo	5 y	434  40/30  nph	170  No insulin

Another factor observed, is that patients with high cholesterol and triglycerides have a notorious decrease of the same.

Table 3. Cholesterol and triglyceride levels before and after duodeno- jejunal exclusion (Arguelles et al)

Sr.	Cholesterol		Triglycerdes
	Post - Op 12 mo	Post - Op	Post - Op 12 mo	Post - Op
1	206 mg/dl	173 mg/dl	273 mg/dl	138 mg/dl
2	164 mg/dl	102 mg/dl	216 mg/dl	226 mg/dl
3	383 mg/dl	123 mg/dl	400 mg/dl	167 mg/dl
4	193 mg/dl	121 mg/dl	531 mg/dl	194 mg/dl
5	195 mg/dl	140 mg/dl	220 mg/dl	175 mg/dl
6	294 mg/dl	172 mg/dl	2638 mg/dl	240 mg/dl
7	181 mg/dl	204 mg/dl	183 mg/dl	165 mg/dl
8	660 mg/dl	183 mg/dl	5540 mg/dl	262 mg/dl
9	267 mg/dl	137 mg/dl	295 mg/dl	206 mg/dl
10	188 mg/dl	160 mg/dl	86 mg/dl	67 mg/dl
	262±151.6	140±32.03	1,038±1751	184±55.88

The criteria required by a diabetic patient for undergoing metabolic surgery are the following:

• Age 20-60 years
• Elevated glycemia levels during fasting
• Not a diabetic for more than 8 years
• Glycosylated hemoglobin (>7)
• Diabetes Mellitus complications
• No major stomach surgeries

Type-2 diabetes is a chronic disease, which causes suffering in many people of different ages, reducing years in quality of life, and therefore surgical treatment can be the solution to meet their expectations.

Quotes:

By means of metabolic surgery, the effect of type-2 diabetes can be reverted.

In some countries in Latin America, the procedure has been done for more than 5 years being 90 % effective in the cure of diabetes.