Bariatric Surgery on Type 2 Diabetes Mellitus Patients in Japan

Abstract

Amidst a worldwide epidemic of diabetes, the World Health Organization estimates that more than 220 million people have diabetes and an estimated 3.4 million people died from consequences of high blood sugar in 2004 . In Japan,a 2009 report from the Ministry of Health,Labour and Welfare stated that there are approximately 8.9 million Japanese who are strongly suspected of having diabetes . Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves. In particular,diabetes increases the risk of heart disease and stroke. Obesity carries with it significant risks of diabetes .Improvement in obesity is attendant with improvements in this ailment , and obese people consequently have been treated through pharmacotherapy,and intervention in life habits,including diet and exercise. Even with such treatment, however,it is very difficult to achieve satisfactory body weight loss.In the last few years many studies have been performed to compare intensive glucose control therapy with standard therapy.Most of the results show that body weight did not change with either intensive glucose control therapy or standard therapy .Additionally,in the case of the Veterans Affairs Diabetes Trial (VADT), body mass index (BMI)of the patients increased from 31.3 kg/m to 33.8 kg/m with intensive glucose control therapy in a median follow-up period of 5.6 years .Moreover, many patients who are initially successful at weight loss then go on to rebound . Thus, promoting weight loss without rebound is a major issue in treatment, especially in severely obese patients. Recently,there has been an increase in patients with a BMI>35 undergoing bariatric surgery .Bariatric surgery generally consists of either gastric bypass, as typified by the Roux-en-Y Gastric Bypass (RYGB),or gastric binding,including vertical banded gastroplasty and laparoscopic adjustable gastric banding. The RYGB method creates a proximal pouch by segmentation of the stomach and the proximal pouch is drained with a Roux limb of proximal jejunum . Vertical banded gastroplasty features a small pouch based on the lesser curvature of the stomach and a mesh or plastic band around the outlet of the pouch to narrow the outlet to about 1 cm .Laparoscopic adjustable gastric banding is similar to vertical banding but uses an adjustable band,which is lined with an inflatable cuffjoined to a small reservoir to allow adjustment of the pouch outflow and meal capacity . There has been a notable increase in studies describing the effect of bariatric surgery on type 2 diabetes patients .