How is diabetes treated surgically?
Bariatric surgery can correct diabetes, but can it really reverse the course of the disease?
Diabetes mellitus and obesity are two closely related diseases. About 90% of people diagnosed with diabetes are overweight or obese according to the American Diabetes Association. The truth is, however, that many patients do not understand how closely related the disease is to one another. It is now well-documented that an overweight patient has a doubled risk of developing diabetes and a patient with pathogenic obesity has a ten-fold higher risk.
It is not exactly understood how these two conditions are related, but the dominant theory holds that the large amount of visceral fat creates a disadvantage for the body’s cells to react to insulin.
The highest association with obesity is related to type 2 diabetes. More than 90% of the population with diabetes have this type of diabetes.
How is diabetes caused in obese patients?
In type II diabetes, or adult diabetes, the pancreas does not produce enough insulin, or the cells in the body are resistant to the action of insulin. Insulin is essential for the body to allow each body cell to use the glucose it takes with food to produce energy.
As a result, unsaturated glucose is concentrated in the blood and this over time causes various complications such as cardiovascular disease (coronary heart disease, hypertension, acute myocardial infarction, heart failure, arrhythmias, cerebrovascular accident, diabetic retinopathy), neurological damage (peripheral neuropathy), renal failure etc.
Traditionally the first line of treatment for type 2 diabetes is lifestyle changes, such as weight loss, the introduction of healthy eating and daily exercise. When all these measures fail to properly regulate diabetes then we add medication. Some medicines help the pancreas produce more insulin, while others help the body use more efficiently produced insulin.
f these drugs do not have the desired effect, then the patient begins to receive insulin treatment.
How effective is diabetes treatment and what differentiates bariatric surgery?
Neil Hutcher, one of the most prominent obesity surgeons and former president of the American Academy of Metabolic and Bariatric Surgery, says traditional diabetes treatments are not working as well as they should. Even with the best drug regulation, patients with diabetes continue to have heart attacks, strokes, amputations, kidney failure, blindness and more.
So, the claim that drug therapy has no risks is completely wrong.
Bariatric surgery on the other hand can offer diabetes treatment at impressive rates that exceed 75% of patients, and certain operations can treat even 85-90% of patients!!!
The conclusion, as Neil Hutcher points out, is that the risks of bariatric surgery in selected centers are ultimately lower than the risks faced by patients treated with medications for diabetes mellitus, and that therefore bariatric surgery is clearly superior than drugs for the treatment of type II diabetes mellitus.
How effectively does bariatric surgery treat diabetes?
According to the American Academy of Metabolic and Bariatric Surgery, there are currently results in more than thirty large multicenter studies worldwide that confirm that diabetes can be treated with bariatric surgery.
A recent study in the Journal of the American Medical Association (JAMA) shows that 73% of diabetic patients who have undergone bariatric surgery have achieved a cure, that is, to return blood glucose to normal levels and stop receiving medication. In contrast, of the patients who received, just pharmaceutical treatment, only 13% of patients were able to suppress their diabetes.
Another major study published in JAMA in 2004, with more than 22,000 patients undergoing bariatric surgery, showed that type 2 diabetes was fully cured in 76.8% of patients and improved in 86% of patients.
The surgeries related to this study were gastric sleeve, gastric bypass, gastric ring, biliopancreatic diversion and more.
Another study published in the Annals of Surgery showed that 83% of gastric bypass patients were cured of their diabetes.
Another two studies published in the New England Journal of Medicine have shown that bariatric surgery significantly reduces the mortality associated with obesity.
Hutcher commented that bariatric operations could also benefit future diabetic patients who are not overweight or obese. In particular, he says, “we can have a reversal of diabetes without causing weight loss and without altering the stomach.”
A general guideline from the National Institutes of Health in the United States on bariatric surgery authorizes bariatric surgery for patients with a Body Mass Index above 40.
The gastric ring has now been approved for patients with a Body Mass Index> 30 and if they have obesity-related conditions such as diabetes.
Other bariatric operations are recommended and approved for patients with a Body Mass Index above 35 and type 2 diabetes mellitus. Many obesity surgeons, including former President of the American Society for Metabolic and Bariatric Surgery, John Baker believe that the threshold of the Body Mass Index 35 is high and should be lowered.
How is diabetes treated by bariatric surgery?
Doctors know that bariatric surgery can reverse diabetes but what they do not know is how it works. Some theories, however, exist, one being that bypassing the food directly into the lower intestine stimulates the secretion of a peptide called GLP1 that can induce increased insulin production.
Another theory holds that interventions that reduce hunger-causing hormones (Grelhin), such as the gastric “sleeve”, help reduce sugar and sweets consumption and help patients better regulate their blood sugar levels.
Another strong point is that reducing body weight, and especially visceral abdominal fat, corrects the resistance of the cells to insulin, thereby correcting diabetes mellitus.
Not necessarily. The decision is up to the patient and his doctor, but in fact any obese diabetic patient should not be banned from surgery. The conclusion is that bariatric surgery can play an important role in treating diabetes, with high success rates, freeing patients from the risks of diabetes, significantly prolonging their life expectancy, and most importantly, giving those people the right to live a healthy and normal life.
Should Every Diabetic Patient Have Weight Loss Surgery?
Not necessarily. The decision is up to the patient and his doctor, but in fact any obese diabetic patient should not be banned from surgery. The conclusion is that bariatric surgery can play an important role in treating diabetes, with high success rates, freeing patients from the risks of diabetes, significantly prolonging their life expectancy, and most importantly, giving those people the right to live a healthy and normal life.