Type 2 diabetes? Bariatric surgery will help!

 

Diabetes and obesityAdult diabetes (type 2 diabetes, noninsulin-dependent diabetes mellitus) – is a severe chronic condition which develops as a result of decreased tissue sensitivity to insulin (pancreatic hormone in charge of glucose processing in the body). In most cases type 2 diabetes is accompanied by obesity, which in turn increases insulin resistance. Statistically, 90% of type 2 diabetes patients are severely overweight.

 

Type 2 diabetes might cause dangerous and irreversible side effects:

  • Diabetic angiopathy – damage to blood vessels, the main cause of limb amputation in patients with diabetes
  • Diabetic nephropathy – damage to the kidneys, eventually leading to dialysis
  • Diabetic retinopathy – damage to the retina, potentially leading to blindness
  • Diabetic polyneuropathy – damage to the peripheral nervous system
  • Diabetic encephalopathy - damage to the central nervous system

 

Indications for bariatric surgery

Bariatric surgery requires changing the natural anatomy of the digestive system, which is why there are very strict criteria for deciding who is a suitable candidate and who isn't.

The indications for bariatric surgery are:

  • The main criteria affecting the decision is the patient's BMI.
    The formula for BMI is weight in kg/(height in meters)2. BMI over 35 is a clear indication for surgery.
  • Another criteria is whether or not the patient suffers from secondary diseases, such as diabetes, ischemic heart disease and others.
  • The patient's family medical history, presence of hormonal pathologies and whether or not the patient tried to lose weight on his own, are all taken into consideration.

The final decision depends on a special medical committee which includes a dietitian, psychologist and a general physician. The patient needs to present results of several diagnostic procedures and tests to the committee for them to make a well-based decision.

 

Bariatric Surgery for Patients with Diabetes

In 1995 a study was conducted in the USA by Dr. Poris involving obese patients with diabetes. All the patients underwent bariatric surgery (weight loss procedure). Follow-up testing showed significant improvement in the metabolism process in the majority of the patients - even before any drastic weight loss. Soon after, the patients no longer required their diabetes medications (including insulin). Their diabetes was cured!

Since 1995, the results of this study have been confirmed many times by other scientists. Furthermore, it has been proven that bariatric surgery is more effective in treating diabetes than medication. Following these findings, the American Society for Metabolic and Bariatric Surgery (ASMBS) has started recommending weight-loss surgery as first-line treatment of obesity accompanied by diabetes.

 

Common Bariatric Procedures

Currently, there are several types of bariatric surgeries offered to patients suffering from obesity accompanied by diabetes:

  • Sleeve gastrectomy (stomach resection) – most common of all bariatric surgeries. During the surgery the stomach size is reduces by removing a large part of it while leaving the gastroesophageal and gastrointestinal sphincters intact. Multiple studies have proven this procedure to be highly effective in patients with diabetes. This can be explained by the fact that at the bottom of the stomach (which is removed during the surgery) a hormone called ghrelin (also called the “hormone of hunger”) is secreted. The metabolic changes caused by the surgery bring an almost immediate improvement of diabetes, long before significant weight loss occurs.
  • Stomach bypass – this procedure is recommended to morbidly obese patients, allowing up to 80% in weightloss. During this surgery the stomach is divided into two parts: the upper (smaller one) remains connected to the esophagus, while the lower part (connected to the duodenum) is excluded from the digestive process. The small intestine is then connected through anastomosis to the small upper part of the stomach. By reducing stomach size and connecting it to the small intestine, the absorption of nutritional fibers is significantly reduced. This procedure, like the sleeve gastrectomy, affects ghrelin secretion causing improvement of diabetes.
  • Biliopancreatic bypass with/without duodenum involvement – this procedure is the most aggressive of all bariatric surgeries, considering the anatomical changes it involves: completely excluding most of the small intestine from the food absorption process. An intestinal anastomosis is performed, sometimes a partial resection of the stomach is involved. This procedure is reserved for the most difficult cases and is rarely performed.
  • Revisional (second) bariatric surgery – in case there is no weight loss, or the patient has gained the weight back, or there is no improvement of the diabetes – a revisional bariatric procedure is performed. Usually, the surgeon will choose a more effective procedure the second time around.

 

The surgeons of HMC’s Weight Loss Center perform all types of bariatric surgeries recommended to patients with type 2 diabetes. Most of the procedures are performed laparoscopically allowing short hospitalization and quick recovery. Don’t risk the potentially devastating effects of diabetes – contact us today!

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