São claras as alterações a nível do controlo glicémico em diabéticos tipo 2 após uma cirurgia de bypass gástrico. No entanto, o mecanismo exacto através do qual ocorre esta melhoria parece ainda um pouco desconhecido. (136)
Como foi referido ao longo do trabalho são vários os estudos que têm sido levados a cabo no sentido de descobrir qual dos factores terá maior relevo ou se será uma associação entre eles que provocará esta alteração. No entanto, resultados de alguns trabalhos contradizem as observações de outros.
Alguns autores consideram que a simples perda de peso induzida por esta intervenção poderá ser suficiente para reduzir a resistência à insulina e facilitar o controlo glicémico. Outros, sugerem que, pelo facto de se verificar uma melhoria do controlo metabólico e uma diminuição dos níveis de glicose sanguíneos poucos dias após o procedimento de RYGBP (mesmo antes de ter ocorrido a redução ponderal mais significativa); poderão existir alterações endócrinas induzidas pela cirurgia, que prevalecem após a perda ponderal; em termos de melhoria do estado dos diabéticos tipo 2. Tendo em conta este facto, o tratamento cirúrgico de bypass gástrico tem sido considerado uma “cirurgia metabólica”.(104)
Após RYGBP, a combinação de duas teorias Foregut e Hindgut produz alterações a nível endócrino, as quais podem ser importantes no tratamento da DM 2.(95) As incretinas (GLP-1 e GIP) têm sido as hormonas mais frequentemente apontadas como as responsáveis por esta optimização do controlo glicémico. O
GLP-1 é a incretina que tem demonstrado, com mais consistência, ter um papel preponderante nesta alteração pós-bypass gástrico.
Para além das incretinas têm sido também atribuídas relações com a redução da glicemia após o RYGBP a outras hormonas como a grelina, a leptina, adiponectina e o PYY, embora com resultados pouco consensuais entre a comunidade científica.
Surgem assim considerações no sentido de encarar a DM 2 também como um distúrbio gastrointestinal. Assim sendo, dado que se desconhecem ainda efeitos a longo prazo da cirurgia de bypass gástrico em diabéticos tipo 2, é necessária alguma prudência na utilização deste procedimento cirúrgico como um tratamento para a doença em causa.
Mais estudos serão necessários no sentido de alcançar evidência científica consistente para que se possa progredir ou não para um “tratamento cirúrgico” da DM 2.
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