Most people considering or undergoing weight loss surgery, called bariatric surgery, are doing so to lose and control weight. Many weight loss surgery patients with type 2 diabetes have found the surgery has improved or resolved their diabetes.
Mohammed Jamal. MD, surgeon in the University of Iowa Obesity Surgery Program at UI Hospitals and Clinics, talks about this possible treatment plan for type 2 diabetes:
Why is type 2 diabetes associated with being obese or overweight?
We have to understand the basic pathophysiology behind type 2 diabetes, which is insulin resistence. This means that patients who are obese or overweight tend to have reasonably high levels of insulin, but is not effective because it's not acting on the receptors in their body. Insulin is a hormone that tends to make patients gain weight and having higher levels of it in the body would result in being obese or overweight. That's why diabetes is seen in close to 30 to 40 percent of obese individuals.
Are all type 2 diabetic patients candidates for surgery?
According to the National Institutes of Health guidelines, only patients who have a body mass index of 35 or more with type 2 diabetes are candidates for the surgery. However, that being said, in many other countries, there's research going on and even individuals who have a body mass index of less than 35 with type 2 diabetes are becoming candidates for weight loss operations.
Is one method of baratric surgery more effective at resolving type 2 diabetes over another?
Yes. Operations that involve a component of malabsorption, like the gastric bypass operation or the biliopancreatic diversion, tend to be more effective and have typically 85 to 90 percent rates of resolution of type 2 diabetes. In the remaining 10 to 15 percent of the patients, type 2 diabetes significantly improves.
This is in contrast to purely restrictive operations like the laproscopic gastric banding procedure in which only the amount of food that one eats is limited, so the malabsorption part does not come into play, and they tend to be less effective and result in only 40 to 50 percent of the patients with type 2 diabetes having their disease cured.
What is a gastric bypass surgical procedure?
In a gastric bypass operation, we create a small pouch or a neo stomach from a patient's stomach that can hold only two to three ounces of food at one time. We then use the patient's intestines to reroute the food and bring it to a distal part of the intestines and bypass the major portion of the stomach and approximately four to five feet of the small bowel. This brings about several hormonal and chemical changes in the body and patient looses weight not only by malabsorption and hormonal changes, but also by restriction of the food
And how is that different from a stomach band surgical procedure?
In gastric banding or a stomach banding operation, an adjustable band is placed at the upper part of the stomach that can be inflated or deflated by injecting saline into it, restricting the amount of food. A gastric banding procedure is a restrictive operation limiting the amount of food that one can eat at one time.
Patients will not have any component of malabsorption that happens with the gastric bypass and the biliopancreatic diversion. It's suggested that the hormonal and chemical changes that happen with the gastric bypass and biliopancreatic diversion, don't happen with banding so the weight loss is less effective and takes longer time for the weight loss to occur.
How quickly is type 2 diabetes affected after a weight loss surgical procedure?
We have seen about 30 percent of the patients come off insulin and oral hypoglycemics right after the surgery, even before they're discharged. The reason is that weight loss is not the only contributor to the resolution of type 2 diabetes. There are several hormonal and chemical changes that happen immediately after the gastric bypass operation that cause remission of the diabetes.
The remaining 70 percent will come off of their medication within six months to a year. The overall rates of complete cure for type 2 diabetes are in the order of 80 to 85 percent, and a majority of the patients will have significant improvement in the type 2 diabetes.
If their diabetes goes into remission after surgery, how likely is it that it will reoccur?
Currently we have close to 14 to 15 years of data from different clinical studies and we see that the reoccurrence of diabetes is related to weight regain, which can happen in a minority of patients after a gastric bypass or other weight loss procedure.
It must be emphasized that the recurrence of the diabetes is related to the weight gain and that in turn could be related to noncompliance with diet or exercise following the gastric bypass surgery. It is a small minority of patients, but yes it can happen if the patients don't follow particular diets and exercise plan after weight loss surgery. |
