title: Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus.
abstract: OBJECTIVE
  This report documents that the gastric bypass operation provides long-term control for obesity and diabetes.
  
  
  BACKGROUND
  Obesity and diabetes, both notoriously resistant to medical therapy, continue to be two of our most common and serious diseases.
  
  
  METHODS
  Over the last 14 years, 608 morbidly obese patients underwent gastric bypass, an operation that restricts caloric intake by (1) reducing the functional stomach to approximately 30 mL, (2) delaying gastric emptying with a c. 0.8 to 1.0 cm gastric outlet, and (3) excluding foregut with a 40 to 60 cm Roux-en-Y gastrojejunostomy. Even though many of the patients were seriously ill, the operation was performed with a perioperative mortality and complication rate of 1.5% and 8.5%, respectively. Seventeen of the 608 patients (< 3%) were lost to follow-up.
  
  
  RESULTS
  Gastric bypass provides durable weight control. Weights fell from a preoperative mean of 304.4 lb (range, 198 to 615 lb) to 192.2 lb (range, 104 to 466) by 1 year and were maintained at 205.4 lb (range, 107 to 512 lb) at 5 years, 206.5 lb (130 to 388 lb) at 10 years, and 204.7 lb (158 to 270 lb) at 14 years. The operation provides long-term control of non-insulin-dependent diabetes mellitus (NIDDM). In those patients with adequate follow-up, 121 of 146 patients (82.9%) with NIDDM and 150 of 152 patients (98.7%) with glucose impairment maintained normal levels of plasma glucose, glycosylated hemoglobin, and insulin. These antidiabetic effects appear to be due primarily to a reduction in caloric intake, suggesting that insulin resistance is a secondary protective effect rather than the initial lesion. In addition to the control of weight and NIDDM, gastric bypass also corrected or alleviated a number of other comorbidities of obesity, including hypertension, sleep apnea, cardiopulmonary failure, arthritis, and infertility. Gastric bypass is now established as an effective and safe therapy for morbid obesity and its associated morbidities. No other therapy has produced such durable and complete control of diabetes mellitus.
authors.affiliation: Department of Surgery, School of Medicine, East Carolina University, Greenville, North Carolina, USA.
authors.forename: W J
authors.initials: WJ
authors.lastname: Pories
authors.forename: M S
authors.initials: MS
authors.lastname: Swanson
authors.forename: K G
authors.initials: KG
authors.lastname: MacDonald
authors.forename: S B
authors.initials: SB
authors.lastname: Long
authors.forename: P G
authors.initials: PG
authors.lastname: Morris
authors.forename: B M
authors.initials: BM
authors.lastname: Brown
authors.forename: H A
authors.initials: HA
authors.lastname: Barakat
authors.forename: R A
authors.initials: RA
authors.lastname: deRamon
authors.forename: G
authors.initials: G
authors.lastname: Israel
authors.forename: J M
authors.initials: JM
authors.lastname: Dolezal
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D015431:Weight Loss
chemical_list: D001786:Blood Glucose