Abstract
The American Diabetes Association's 57th Annual Advanced Postgraduate Course was held 5–7 February 2010 in San Francisco, California. Free webcasts of the talks from the 57th Annual Advanced Postgraduate Course are available at http://professional.diabetes.org/pg10. ### Bariatric surgery in diabetes Lee Kaplan (Boston, MA) discussed new information based on studies of bariatric surgery in diabetes. Surgery is performed in 0.25% of Americans with obesity, so it is unlikely that it in itself can address the U.S. diabetes or obesity issues, but lessons from its use may shed light on the approach to obesity and diabetes for the overall population. The biology of obesity suggests that it is caused by inactivity and overnutriton and likely stress as well. There is a huge burden of obesity-associated illness, including malignancy, and obesity has a devastating effect on quality of life and also on what is termed societal “efficacy” and socioeconomic status. The physiology of obesity involves central regulation of food intake, nutrient handling, and energy expenditure, with adipose tissue energy stores regulating levels of signals such as leptin, and information from liver, muscle, and bone on metabolic needs coupled with information from the gastrointestinal tract and sensory organs regarding the quantity and quality of nutrient intake. A unifying theme is the body's defense of fat (rather than of total body weight). Surgery includes the Roux-en-Y combination gastric restriction and bypass (RYGB) of distal stomach, duodenum, and proximal jejunum, which is the most effective, and may be the most appropriate, for diabetes treatment. Adjustable gastric banding is a gastric restriction procedure, while vertical sleeve gastrectomy removes the greater curvature of the stomach, acting in a fashion very different from gastric banding, causing more rapid gastric emptying. In the Swedish Obesity Study, lifestyle was compared with bariatric procedures. Gastric banding led to ∼20% weight loss initially, which decreased to 14% …
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