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Bariatric Surgery and DiabetesWho Should Be Offered the Option of Remission?
Jonathan Q. Purnell, MD;
David R. Flum, MD, MPH
JAMA. 2009;301(15):1593-1595.
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Diabetes has been considered the model chronic disease—progressive, managed rather than cured, and burdensome to patients and the health care system. But all this changed with the observation that many patients undergoing surgically induced weight loss appear to have a form of lasting remission of their diabetes.1 Now that the medical community can offer a chance for diabetes remission, why has surgery not become the standard of care for severely obese patients, and what public health strategy could offer bariatric surgery in a sensible manner?
Although conventional weight loss approaches improve insulin sensitivity, long-term weight reduction is rare and therefore an unreliable means to achieve diabetes remission. Conversely, while purely restrictive surgical procedures improve glucose control in parallel with weight loss2 (and therefore the effect is more variable), gastric bypass leads to marked improvements in diabetes (near or complete normalization of . . . [Full Text of this Article]
Author Affiliations: Department of Medicine, Oregon Health & Science University, Portland (Dr Purnell); and Department of Surgery, University of Washington, Seattle (Dr Flum). Dr Flum is Contributing Editor, JAMA.
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