Adipositas-Chirurgie und Diabetes

Abstract

Diabetes mellitus is one of our most serious diseases. It accelerates the development of atherosclerosis, doubles the risk for stroke, and increases the risk of heart attacks two- to threefold. As it damages the microvasculature, diabetes produces retinopathies, blindness, nephropathy, and neuropathy. The economic impact of the diabetes is enormous and may well be twice as high as the increase in health care costs resulting from inflation. Although the exact prevalence is unknown, more than 6.3 millions of Germans are suggested to be diabetic. Many remain undiagnosed. The disease is generally classified into two groups: type I diabetes or insulin-dependent diabetes and the far more common type II diabetes or non-insulin-dependent diabetes mellitus (NIDDM), which accounts for more than 95% of the cases. The basis of the current treatment of NIDDM is the maintenance of euglycemia and normal insulin levels. Unfortunately, euglycemia cannot be achieved in most patients with NIDDM because they are usually overweight and resistant to dietary controls. In fact, their excess weight is a major factor in precipitating the overt diabetes, especially in those hereditary predisposed. Among obese diabetics, 94% of the NIDDM prevalence was attributed to obesity. The bariatric procedures are effective: in addition to induce long-term weight loss, they help to control hypertension and reestablish functional effectiveness in many of those patients handicapped by severe obesity.