1. Caitlin McGrath and Paul Schubert Lock Haven University of Pennsylvania 2012

2. Background  Growing Problem  140% increase in Obesity (7)  Concomitant growth 9.3%

3. Background Continued  Diet and Exercise Important and works Rarely durable (1)  Current Standards of Treatment Sensitizers (Metformin, Pio/Rosiglitizone) Insulin secretagogues (Glipizide) Insulin Injections (Humolog, Lantus)  Expensive Requires increased amounts of medication as time goes on (1)

4. Background Continued  BARIATRIC SURGERY

5. Methods  Literature Review Effectiveness of methods Power of their results

6. Results  Range of Results Lap-Gastric Band – 48% Biliopancreatic Diversion with Duodenal Switch – 98% 70-95% with other methods

7. Discussion - Effectiveness  Viable Option Effectively resolves diabetes Cosmetic Cost effective  Payment Out of pocket HTN medications  Surgical Complications

8. Discussion - Physiology  Days to weeks  Theories Starvation Grehlin GLP-1 Unknown

9. Disscussion – Starvation  Most obvious  Decreased caloric intake

10. Disscussion – Ghrelin  Makes you hungry  Low levels post bariatric surgery Possible reason for diabetes resolution

11. Disscussion – GLP-1  Multiple effects Increases insulin release in response to hyperglycemia Decreases pancreatic beta cell apoptosis  Increased after bariatric surgery

12. Disscussion – Which surgery?  Gastric Banding vs More invasive  Complications

13. Discussion – Oral Medications  Miracle Cure?  Oral Medications  Fewer diabetes complications

14. Conclusion  Must have a change  Don’t have oral medications yet  Bariatric Surgery is the best we have

15. References  1. Arroyo, K., Kini, S.U., Harvey, J.E., Herron, D.M. (2010). Surgical therapy for diabesity. Mount Sinai Journal of Medicine 77(5), 418-430.  2. Buchwald, H., Estok, R., Fahrbach, K., Banel, D., Jensen, M.D., Pories, W.J., Bantle, J.P., Sledge, I. (2009). Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. The American Journal of Medicine, 122 (3), 248-256.  3. Buchwald, H., Avidor, Y., Braunwald, E., Jensen, M.D., Pories, W., Fahrbach, K., Schoelles, K. (2004). Bariatric surgery: a systematic review and meta-analysis. The journal of the American medical association 293(14), 1728.  4. Cremieux, P.Y., Ghosh, A., Yang, H.E., Buessing, M., Buchwald, H., Shikora, S.A. (2008). Return on investment for bariatric surgery. American journal of managed care 14(11), 5-6.  5. Cummings, D. (2009). Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery. International Journal Of Obesity (2005), 33 Suppl 1S33-S40.  6. Gan, S., Talbot, M., & Jorgensen, J. (2007). Efficacy of surgery in the management of obesity-related type 2 diabetes mellitus. ANZ Journal Of Surgery, 77(11), 958-962.  7. Lin, E., Davis, S., Srinivasin, J., Sweeney, J., Ziegler, T., Phillips, L., Gletsu-Miller, N. (2009). Dual Mechanism for Type-2 Diabetes Resolution after Roux-en-Y Gastric Bypass. The American Surgeon, 75(6), 498-503.  8. Mingrone, G., & Castagneto, M. (2009). Bariatric surgery: unstressing or boosting the beta-cell?. Diabetes, Obesity & Metabolism, 11 Suppl 4130-142.  9. Villamizar, N., Pryor, A.D. (2011). Safety, effectiveness, and cost effectiveness  of metabolic surgery in the treatment of type 2 diabetes mellitus. Journal of Obesity, 2011, 1-6.