HJAR Jul/Aug 2022

56 JUL / AUG 2022 I  HEALTHCARE JOURNAL OF ARKANSAS BARIATRIC COLUMN BARIATRIC IN 1992, Walter J. Pories, MD, published an article inAnnals of Surgery with the provoca- tive title, “Is Type II Diabetes Mellitus a Surgi- cal Disease?”In the paragraphs that followed, Pories documented 515 consecutive gastric bypass patients over an 11-year period. He showed a nearly 90% resolution of diabe- tes in this cohort of patients. He noted diets don’t work in the morbidly obese, and “the general course of their illness is a pattern of ever-increasing weight, worsening diabetes, and progression of diabetic complications.” His conclusion was that the gastric bypass is an effective treatment for morbidly obese diabetics. As a bariatric surgeon, I am blessed to have a front row seat to stunning medi- cal transformations. Scott is a 58-year-old male from Camden, Arkansas, and a patient of mine. When we first met in May 2021, he weighed 410 pounds and already suffered a heart attack several years prior. Looking at his health record, it wasn’t hard to see why. His diabetes necessitated 100 units of insulin a day through his insulin pump. Yet even the insulin pump didn’t keep his diabetes under tight control, because his HbA1c would rou- tinely exceed 9. In addition to the diabetes, he also had hypertension and sleep apnea. His genetics were working against him as well with a father and several grandparents that had suffered from heart disease. Scott was a ticking time bomb. After his cardiologist and nurse practitioner recommended bariatric surgery, he came to us requesting assistance. Scott is just one of the hundreds of diabet- ics we see every year. All of them are look- ing for relief from this horrible and chronic disease. Fortunately for them, we have reams of information on the positive effects of bar- iatric surgery on diabetes, and the amount of that information grows with each pass- ing year. Over the past 30 years, there have been hundreds of manuscripts that analyze the effect that bariatric surgery has on diabetes. In his landmark meta-analysis from JAMA (Journal of the American Medical Associa- tion) in 2004, Henry Buchwald, MD, PhD, analyzed over 136 studies that included over 22,000 patients and noted that there was an 83.7% resolution of diabetes after gastric Is Type 2 Diabetes a Surgical Disease? bypass. Stacy Brethauer, MD, documented in An- nals of Surgery in 2013 the results of 217 patients with type 2 diabetes six years after their bariatric procedure. He noted that 84% of patients had their diabetes either cured or improved after 5+ years. Brethauer also noted that 50% of patients were off all diabe- tes medications five or more years out from their procedure. Beginning in 1987, a large, prospective cohort study known as the Swedish Obe- sity Subjects (SOS) study was publishing its findings. This study matched 2000 bariatric surgical patients to 2000 nonsurgical control. This resulted in a treasure trove of informa- tion for researchers. In 2012, they published in the New England Journal of Medicine (NEJM) that bariatric surgery reduces the incidence of type II diabetes by 78% in obese patients. The STAMPEDE trial is a three-arm, ran- domized controlled trial that followed the results of 150 patients with type 2 diabetes after intensive medical therapy (IMT), IMT plus Roux-en-Y gastric bypass, or IMT plus