"It is a turning point for diabetes care." With 20 years of data, we can really see how surgery can improve a range of health - in particular cardiovascular risk, "said Dr. Francesco Rubino, Director of the Congress and gastrointestinal metabolic Surgery Director at NewYork-Presbyterian Hospital/Weill Cornell Medical Center."
Type 2 diabetes is not technically a cardiovascular disease, experts say could also be one, in view of the corrosive effects of sugar in the unregulated blood in the heart. According to the American Heart Association, at least 65% of people die of a form of disease stroke diabetes heart.
Dr. Lars Sjöström, Professor at the Institute of medicine, Gothenburg, Sweden, presented new data on the study of Swedish obese subjects (SOS). Reported 20 years of data comparing surgery Bariatric 2.010 with patients non-surgical herd who received medical treatment or change of lifestyle of obesity.
"Type 2 still was regarded as a chronic disease and for life, but in the long term data show discount in 70% of patients after two years of follow-up,", said. "Thirty percent is still in remission 15 years after bariatric surgery." "Even more remarkable, 20 years, we have seen that Bariatric Surgery reduced by 80% in obese patients who do not have the disease at the beginning of the study of new cases of diabetes."
Dr. Sjöström concludes that the preventive effect of surgery appears to be stronger and more durable than their ability to maintain the remission in the long term. Just as surprising, that the incidence of new cardiovascular events, infarction myocardial or cerebral vascular accident - was 30% lower in postoperative patients be treated conservatively counterparts.
A study based on Utah presented similar clinical results. After gastric bypass surgery, patients have been admitted to having a greater reduction in blood pressure, heart rate, triglycerides, lipoprotein cholesterol of low-density (LDL) and insulin resistance that patients in severely obese patients who have been treated by changing medications and lifestyle. The surgical group has also experienced positive changes in the cardiac function and "geometry" - a subtle redesign of the components of the heart leading to greater efficiency. The principal investigator of the study, Dr. Ted Adams, University of Utah School of medicine, believes the new data support, the use of Bariatric Surgery to prevent cardiovascular complications associated with obesity and type 2 diabetes.
Digestive tract: a new target for the treatment and research
"The idea that the gut can provide advice for the treatment of diabetes is very promising." It also represents an entirely new way to try to think on a disease that is notoriously difficult to control, "said Dr. Rubino, who is also Professor of surgery at the Weill Cornell Medical College."
Surgery Bariatric, especially the proceedings involving the Floodway as opposed to the restriction of the gastrointestinal tract (GI), appears to change the hormonal secretions of the intestines, explains Dr. Rubino. These changes may be responsible for the impressive success of the surgery to improve or even solve the disease in the majority of patients.
In portions of circumvention of the jejunum and duodenum - the top of the digestive tract just below stomach - such as gastric bypass procedures appear to function through a mechanism of action that occurs too quickly to be related to weight loss. Although scientists still engage in a lively debate on how and why it works in surgery, there is a growing consensus that the anatomical changes in the gastrointestinal tract, they play a role much more important in the control of diabetes than previously believed.
Dr. Lee Kaplan, an authority on medicine obesity and presenter of the Congress, explains: "pharmaceutical and biotechnology industries have developed drugs for novel destination of diabetes of the digestive tract, but the process is still at a relatively early stage."
"Recently, for example, we have seen the emergence of a new class of drugs designed to modify the action of hormones based on the intestine, as incretins that play an important role in the production of insulin." "However, the molecular nature of the intestine superior continues to be assigned and understood," adds Mr. Kaplan, who is Professor of medicine at the Faculty of medicine at Harvard and Director of the Centre for research of obesity in Massachusetts General Hospital.
Presentations Congress understood also Nobel Prize winners Michael s. Brown and Joseph l. Goldstein award. Its main conference focused on the role of ghrelin gastrointestinal hormone in the regulation of processes biochemical key involved in energy metabolism. Ghrelin has been linked to obesity, mainly because of its ability to stimulate the release of growth hormone.
Regardless of the details of this discussion, adds Dr. Rubino, the idea of the gut as endocrine organs, which could be responsible for the failure of hormone in diabetes, yet is being tested, both in industry and the community Medical University. At stake are new drugs, new devices and surgical improvement of methods for people living with and too often die from diabetes. "Some of us provide a paradigm shift in our understanding of the disease while others question such a change", explains Dr. Rubino. "But perhaps how is learning at this Conference on the clinical benefits of surgery diabetes and fundamental science underlying its success".
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