Oscar Brasesco is director of the OCMI program (obesity and mini invasive surgery) and president of Saco (Argentine Society of Obesity Surgery).At present, together with your work team, analyzes the effects of type 2 diabetes and proposes the surgical solution as a way to improve the evolution of the disease.

World Diabetes Day, which was commemorated this month, is a campaign that brings together more than 160 countries.It was established in 1991 by the World Health Organization (WHO) and the International Federation of Diabetes (FID) in response to the increase in diagnoses of people with this pathology.The objective is pedagogical: it is about educating about its prevention and control, as well as reducing the impact of satellite problems such as arterial hypertension and dyslipidemia - the elevated concentration of lipids in the blood.

Metabolic surgery, through the Gastric By Pass, causes hormonal changes that are fundamental in the treatment of diabetes regardless of weight decrease.Hence, both obese patients and those who are not benefited.

- How did he specialize in metabolic surgery?

- That we do metabolic surgery, in general, we come from bariatric surgery, which is a surgical procedure used to treat morbid obese.In general, these are people who have associated diseases and one of them is diabetes.For many years, we have operated on obese patients and we noticed that diabetes was "resolved" as a consequence of weight loss.At present, we know that - of course - weight loss benefits the values ​​of this disease, although surgery has a much more early and powerful effect: the “hormonal effect”.In this sense, surgery produces the increase in the secretion of incredine hormones involved in carbohydrate metabolism and lower blood glucose.In this way, patients solve diabetes immediately without gaining weight.Specifically, metabolic surgery is not only to treat obese patients but for diabetics, because the solution of the disease has nothing to do with weight loss directly, but with the hormonal change that surgery produces.

- When he points out that patients solve the disease, does it refer to the cure?I understand that diabetes is a chronic disease.

- We still cannot talk about cure in a specific sense, but that diabetes is resolved.

- And what is the difference between "solving" and "cure"?

–It must say that, through surgery, the diabetic ceases to be, does not use more medications to control it and acquire normal blood glucose values.In practical terms it seems that it is the same but we do not say that it was cured because we lack the proof of time to point out.Very recently, metabolic surgery is performed and, so far, the results are very good and the people intervened - in most cases - do not fall.However, the truth is that we do not have a tracking at 15 or 20 years to verify full effectiveness.When this happens, we can talk about cure and not only a solution.

- In this sense, is surgery the last option with diabetic patients?

"No, it's not the last."What is proposed from the different medical societies is the surgical solution in those who, after two years of treatment, do not have a good metabolic response.The diabetic individual, as his disease progresses, spends the pancreas.With surgery, the increasing factor increases and hormones - such as LPG1 - begin to stimulate pancreatic insulin secretion and diabetes is resolved.This, of course, works in people who have "pancreatic reserve", that is, they have not spent the pancreas.In thisSense, has better chances a patient who has two years of evolution of the disease than those who have ten years of diabetes.

–The treatment you propose is for type 2 diabetes ...

–Yes, for type 1 diabetes, surgery is not useful.But type 1 and type 2 are etiologically two completely different diseases.In type 1 - the thin, youthful individuals, who use insulin yes or yes - the pancreas have suffered a serious deterioration process.The patient runs out of pancreas, even if the causes are not - until the moment - too clear.Type 2 diabetic is different: the pancreas works, but the incredine factor is what is not used correctly.Therefore, they can use insulin or not use it, it depends on the individual.The two patients share the symptoms, that is, in the two glycemia rise, but etiologically they are different.That is why surgery works in some and not in others.

- Is metabolic surgery performed using gastric By Pass or gastric belt?

- When we talk about metabolic surgery we only refer to gastric by pass.The gastric manga, for example, improves diabetes because the operated individual weight.In fact, the patient who is obese and diabetic, if he makes diets, also improves the evolution of the disease.But, in this case, the important thing is the metabolic effect - which is independent of weight loss - produced by the By Pass that stimulates the secretion of LPG1 and this the secretion of insulin, because in patients who are not so obese, ifOne does not perform a technique that meets the metabolic effect, the intervention does not work.

- How is the recovery after the Gastric By Pass?

–The patient is internal and has surgery that lasts a little more than an hour.He leaves the operating room and the first day by theperatory does not eat anything.Go to a common room and at two hours you can walk all over the sanatorium.That day does not take anything, but the next one begins with liquids and retires to the house.You can do what you want and drink broth, water, tea and jelly.He does not feel anything hungry, rather perceives as if the food did not exist.On the seventh day he returns to the consultation, a drain that had been put on him is removed and is ready to drink yogurt and milk (skimmed).At 15 days it returns, the points of the surgical wound are removed and consistency foods processed as chicken and fish are added.The third week begins with normal consistency foods and, progressively, new nutrients will be added to a diet that will be as protein as possible for the care of muscle mass.At six months, when you go to eat with a patient who has been operated, she doesn't even realize.Simply, the individual eats more slowly and chews better than the rest of the diners.

- But if he is a patient with morbid obesity accustomed to an abundant caloric load in his daily diet, what happens to his eating habits after the operation?Is hunger?

- Yes, for this hormonal change.There is a hormone that is modified with surgical intervention, which is ghrelin.An oxygenic hormone related biochemically to growth hormone.Specifically, this hormone, which in the morbid obese has an altered secretion pattern, in the person who crossed the surgery - almost - to zero levels.This causes the individual not to be hungry.This is the big difference between the Gastric By Pass and the rest of the surgical techniques.The patient with a gastric band eats, fills quickly, but is hungry before and after having eaten.

–I told me before metabolic surgery through the technique of gastric By Pass is applied in obese and non -obese individuals.In obese patients, weight loss causedFor the operation it is essential for the improvement in your health.However, what happens to those who are not obese and metabolic surgery are performed to improve diabetes?

–The organism is wise and patients who are not too overweight go down very little.With a By Pass, there is no person who goes down more than he has to go down.As the care of muscle mass is fundamental, we recommend and insist on two things: a hyperproteic diet and physical activity.Ten days after being operated, the patient begins to go to the gym.