Type 2 diabetes is the most common type of diabetes and occurs when the body becomes resistant to the hormone insulin, which controls blood sugar levels. The disease now affects around 200 million people worldwide, and diabetes-related deaths are expected to increase by more than 50% in the next 10 years.
Unfortunately, this disease can lead to serious health problems, including heart disease, stroke, high blood pressure, kidney failure, blindness, skin sores, nerve damage (neuropathy), sexual dysfunction and cognitive decline.
Initial treatment for type 2 diabetes focuses on lifestyle changes, such as weight loss, exercise, dietary changes and anti-diabetes medications. The goal is to balance blood sugar and prevent further damage to the body. However, for many people, diabetes worsens over time and may require more types of medication and higher doses to keep blood sugar under control. Type 2 diabetes is usually a progressive disease, and most people will need treatment throughout their lives.
What is type 2 diabetes surgery?
Obesity and type 2 diabetes are two conditions that are linked to problems in the body’s metabolism. Approximately 90% of type 2 diabetes is caused by being overweight and obese.
Evidence gathered over the years from bariatric surgery shows the effectiveness and durability of diabetes control achieved after bariatric surgery. Metabolic surgery has emerged as a field dedicated to the creation of bariatric surgery procedures specifically targeting diabetes treatment.
Changes that lead to weight loss after bariatric surgery can lead to remission of type 2 diabetes. Most importantly, it improves blood sugar control by making changes in metabolism that affect intestinal hormones, and can reduce/stop medication use.
Bariatric surgery can be recommended even for type 2 diabetic patients with mild obesity.
How does bariatric surgery affect diabetes?
Bariatric surgery changes the way your digestive system works in a way that is beneficial for people with type 2 diabetes. The surgery
- makes you feel full faster, which means you eat less.
- changes the way your gut hormones work. This affects how your body produces insulin.
- increases the amount of bile acids that make your body more sensitive to insulin.
- improves how your body uses insulin, which lowers blood sugar levels.
How successful is diabetes surgery?
Almost all people who have surgery to treat diabetes experience improvement. This can include a decrease in blood sugar, less need for medication, and improvement in diabetes-related health problems within a few days after surgery. 78% of patients experience remission and no longer need diabetes medications.
Who is suitable for diabetes surgery?
Scientific research supports the use of diabetes surgery in patients with type 2 diabetes who have a body mass index (BMI) of 30 and above.
What are the types of diabetes surgery?
The most common surgical treatments for diabetes include the following:
- Roux-en-Y Gastric Bypass (RYGB): It is an effective bariatric surgery method that allows you to lose 60-80% of your excess weight. Compared to sleeve gastrectomy surgery, it offers more successful results in losing excess weight. It regulates carbohydrate metabolism, increases insulin sensitivity and can reduce the need for medications used in diabetes treatment. It can also contribute to the complete or partial improvement of obesity-related health problems such as reflux, high blood pressure, high cholesterol and sleep apnea.
- Mini Gastric Bypass:It has proven to be an effective way for overweight people to lose weight and often puts type 2 diabetes into remission.
This simple, safe and effective procedure works by reducing the size of your stomach by creating a smaller stomach “pouch” that is separated from the rest of the stomach. When you eat, the small pouch of your stomach fills and sends signals to your brain that you are satisfied and comfortable with smaller portions of food.
Candidates with gastroesophageal reflux disease (GERD) or bile reflux are not candidates for mini gastric bypass. Traditional gastric bypass surgery is recommended for such patients.
- SASI (Single Anastomosis Sleeve Ileal) Bypass: It is one of the most successful operations in the treatment of type 2 diabetes. The most important feature of this success is that it largely preserves the natural digestive function while providing the same goal compared to other operations.
SASI is a more simplified surgical method that represents a combination of the same proven metabolic effects provided by other types of bariatric surgery.
Your surgeon will decide which operation is right for you by evaluating your health condition.
Frequently Asked Questions About Diabetes Surgery
Who is a candidate for diabetes surgery?
Diet and exercise remain key steps in managing diabetes. However, many patients are unable to achieve and maintain a healthy weight, which can lead to poor blood sugar control despite multiple medications.
Diabetics who do not want to take lifelong medications and prefer a surgical procedure to reverse their diabetes may also consider metabolic surgery.
Candidates typically include those with a body mass index (BMI) of 30 or higher, especially those with type 2 diabetes who are not adequately controlled despite lifestyle changes and medications. The American Society for Metabolic and Bariatric Surgery recommends considering surgery for patients with a BMI of 30 to 35 who have not achieved adequate diabetes control with traditional methods.
What are the benefits of diabetes surgery?
Beyond significant weight loss, these surgeries can lead to remission of type 2 diabetes, reduced dependence on diabetes medications, and improved quality of life. Studies have shown that bariatric surgery can provide more effective blood sugar control than medical and lifestyle interventions.
What are the risks associated with diabetes surgery?
As with any surgical procedure, risks include infection, bleeding, and anesthesia-related complications. Potential risks specific to metabolic surgeries include nutritional deficiencies, dumping syndrome, and intestinal obstructions. Long-term follow-up is essential to effectively monitor and manage these risks.
How should you prepare for diabetes surgery?
Preparation involves a comprehensive assessment by a multidisciplinary team, including endocrinologists, surgeons, dietitians and psychologists. This assessment ensures that the patient is physically and mentally ready for the surgery and its aftermath. In addition, managing blood sugar levels and improving overall health before surgery are important steps.
Do not eat or drink anything after midnight the day before surgery and the morning of surgery. Patients who do not have delayed stomach emptying may drink clear liquids up to 2 hours before their scheduled arrival at the hospital, at the discretion of the doctor.
What is the expected recovery period after surgery?
Recovery varies depending on the procedure. Compliance with the diet, regular physical activity and not skipping medical check-ups are vital components of the recovery process.
What should I watch for after surgery?
After surgery, the patient should focus on preventing hypoglycemia and maintaining blood sugar control while returning to their diet and medication regimen. Keeping blood sugar under control is critical to preventing infections and complications from hyperglycemia.
Postoperative care for diabetic patients also includes close monitoring of electrolytes and fluid balance. This comprehensive approach helps diabetic patients undergo surgery have a smoother recovery and minimize complications.
Why is blood sugar management important before surgery?
Managing your blood sugar before surgery can help reduce your risk of infection and other problems after surgery.
Can children undergo diabetes surgery?
Current data show that bariatric surgery in children and adolescents is as safe and effective as it is in adults. The decision about which procedure is appropriate for the patient is a complex procedure that involves the child and family, as well as the surgical team.
Sources:
- American Society for Metabolic and Bariatric Surgery (ASMBS)
- UK National Health Service (NHS)
- Lancet Diabetes and Endocrinology
- Journal of the American Medical Association