3 research outputs found
Is type II diabetes mellitus (NIDDM) a surgical disease?
Since February 1, 1980, 515 morbidly obese patients have undergone
the Greenville gastric bypass (GGB) operation. Of these,
212 (41.2%) were euglycemic, 288 (55.9%) were either diabetic
or had glucose intolerance, and 15 (2.9%) were unable to complete
the evaluation. After the operation, only 30 (5.8%) patients remained
diabetic (and 20 of these improved), 457 (88.7%) became
and have remained euglycemic, and inadequate data prevented
classification of the other 28 (5.4%). The patients who failed to
return to normal glucose values were older and their diabetes
was of longer duration than those who did. The effect of the
GGB was not only limited to the correction of abnormal glucose
levels. The GGB also corrected the abnormal levels of fasting
insulin and glycosylated hemoglobin in a cohort of 52 consecutive
severely obese patients with non-insulin-dependent diabetes. The
GGB effectively controls weight. If morbid obesity is defined as
100 pounds over ideal body weight, 89% of the patients are no
longer "morbidly" obese within 2 years. In most patients, the
control of the weight has been well maintained during the 11
years of follow-up; most of the upward creep in weight of 20.8%
between 24 and 132 months was from the 49 (9.5%) patients
who had staple line breakdowns between the large and small
gastric pouches. Non-insulin-dependent diabetes, previously
considered a chronic unrelenting disease, can be controlled in
the severely obese by the gastric bypass. Whether the correction
of glucose metabolism affects the complications of diabetes is
unknown. Whether the gastric bypass should be considered for
patients with advanced non-insulin-dependent diabetes but who
are not severely obese deserves consideration. The GGB has an
unacceptably high rate of staple line failure. Accordingly, the
authors have recently changed their procedure to one that divides
the stomach rather than partitions it with staples. Originally published Annals of Surgery, Vol. 215, No. 6, June 199