Being overweight or obese brings with it additional risks for the development of a series of additional diseases (also known as “coborbidities”), with severe type 2 diabetes being the most common. Numerous studies have demonstrated that losing weight helps decrease the risk of developing diabetes, as well as manage the disease. However, losing weight alone is not always easy, which is why there are medically supervised weight loss programs, including behavioral changes, pre-packed meals, pharmacotherapy and surgery, that can support and enhance the weight loss process.
Bariatric surgery, which includes several different procedures, can temporarily or permanently reduce the size of the stomach in order to alter the digestive process. There are three different types of bariatric surgery: restrictive surgeries, malabsoptive/restrictive surgeries, and electrical device implantation surgeries. Adjustable gastric banding and sleeve gastrectomy are restrictive weight loss surgeries, while gastric bypass surgery, also known as Roux-en-Y gastric bypass, offers a combination of malabsorptive and restrictive surgery. The bioliopancreatic diversion is a more extreme form of malabsorptive and restrictive surgery, since up to 70% of the stomach is removed, and the Maestro rechargeable system is an electric device that is placed in the abdomen to reduce food intake.
Bariatric Surgery and Diabetes: Are the Procedures Recommended?
Not all diabetics are recommended to receive bariatric surgery, and the most suitable weight loss method should always be discussed with a physician first, taking into consideration the patient’s specific health characteristics. However, bariatric surgery and diabetes have become closely associated, with most of the procedures being proven effective in putting diabetes into remission, either through the management of insulin or the reduction of body weight. Diet and exercise are always part of a medically-supervised weight loss program, but only by changing these habits, diabetics are less likely to achieve the goals wanted than healthy patients. Therefore, surgery can enhance the results of these behavioral changes.
In order to be eligible for bariatric surgery, patients need to have a Body Mass Index (BMI) higher than 40, which is consistent with morbid obesity, as well as suffer from a severe comorbidity, or health problem as consequence of obesity, including type 2 diabetes, heart disease, high cholesterol of sleep apnea. In addition, patients must have tried and failed in previous attempts to lose weight and must be fully conscious about the procedure and its risks.
How Does Bariatric Surgery Impact Diabetes?
An analysis conducted by Andrei Keidar, MD, and published by the American Diabetes Association revealed the benefits of bariatric surgery for patients who suffer from diabetes. Bariatric surgery has been used for over 15 years as a treatment for obesity-related diabetes, with proven results in decreasing morbidity and mortality associated with the disease following the surgery. In some cases, even diabetes remission is achieved. Behavioral programs are effective, but they have an average failure rate of 95% at one year — a problem overcome by surgery. In this way, bariatric surgery and diabetes are becoming increasingly associated.
There is no standard procedure specifically for diabetics, but studies have demonstrated that bypass procedures, the Roux-en-Y gastric bypass and the biliopancreatic diversion are more effective than other surgical procedures to treat obesity and diabetes, and patients’ insulin levels return to normal just days following the surgeries. In about 87% of the cases, diabetics submitted to bariatric surgery are able to lose weight and observe improvements in the disease. Despite some of the risks associated with bariatric surgery, the overall medical opinion is that the benefits are more significant.