Visualizing Beta Cells in Patients With Remission of T2DM After Bariatric Surgery

Obesity and T2DM The prevalence of Type 2 Diabetes Mellitus (T2D) in the Netherlands is 600.000-800.000 and each year ~70.000 new patients are diagnosed. This increasing number of patients with T2D is closely correlated with the obesity epidemic. In women, over 50% of T2D risk can be accounted for by obesity. Also, over 85% of T2D patients are overweight and ~50% are obese.

Obese patients with T2D not only have elevated glucose levels but are also at risk to develop dyslipidemia and hypertension. This clustering of cardiovascular risk factors leads to an increased risk of micro-and macrovascular long-term complications. In fact, patients with T2D have a 2-4 times increased risk for cardiovascular disease. These complications seriously decrease the quality of life and life expectancy of T2D patients. The burden of this disease not only affects these patients but our society as well. Health care costs with respect to diabetes amounted 814 million euro in 2005 in the Netherlands and indirect costs because of absence of work are unknown but thought to be substantial.

Weight loss is perhaps the most important therapeutic intervention in obese patients with T2D. Weight loss intervenes in the underlying pathophysiology and restores insulin sensitivity and sometimes even insulin secretion. In addition, it improves dyslipidemia and hypertension. In contrast, most pharmacological interventions only relieve the symptoms of the complex disease process underlying T2DM whilst the disease process itself is not addressed and even progresses in the course of time. Unfortunately, the effect of weight loss interventions such as diet and lifestyle or even drugs is often modest (3-5 kg) and short-lived.

Bariatric surgery and T2DM remission Weight reducing surgery, i.e. bariatric surgery, is the only intervention that leads to persistent weight loss and it is superior above conventional (non-surgical) treatment.

Bariatric surgery can be divided into restrictive (gastric band) and malabsorptive procedures (biliopancreatic diversion) or a combination of the 2 (Roux-en-Y Gastric Bypass, RYGB).