According to the Centers for Disease Control and Prevention, more than 29 million people living in the United States has diabetes. Over 90 percent of these individuals has type 2 diabetes which is closely associated with overweight and obesity. Diabetes is a serious disease that can lead to increased risk for serious complications such as hypertension, dyslipidemia, cardiovascular disease, heart attack, stroke, vision impairment, kidney disease, and amputations. Moreover, type 2 diabetes reduces life expectancy by 12 to 14 years. Keeping blood glucose—also called blood sugar, under control can reduce your risk of developing diabetes-related complications.
Lifestyle intervention including weight-loss, diet, exercise; and diabetes medications are used to manage type 2 diabetes. However, when medicines and lifestyle changes are not enough to manage diabetes in obese individuals, bariatric surgery – also called metabolic surgery is a valid option. The American Society for Metabolic and Bariatric Surgery says surgery can improve type 2 diabetes in 90 percent of patients and cause remission (a state in which all signs and symptoms of diabetes are gone) of type 2 diabetes in 78 percent of them.
“Metabolic surgery is playing a more prominent role in diabetes management because of emerging data showing that surgery can be superior to medical therapy in controlling diabetes,” says Eduardo Grunvald, MD, Program Director, UC San Diego Weight Management Program, the Bariatric and Metabolic Institute at UC San Diego Health.
In fact, according to a recent study published in the New England Journal of Medicine, gastric bypass and sleeve gastrectomy—two types of bariatric surgery, were found to be better than medical therapy in helping people with type 2 diabetes significantly reduce and maintain glucose control and sustained weight loss. Bariatric surgery was also associated with a greater reduction of diabetes and heart disease medications, and improvement in quality of life compared to medical therapy.
The three types of metabolic surgery used most often for people with type 2 diabetes include laparoscopic adjustable gastric band, gastric sleeve surgery, also called sleeve gastrectomy and gastric bypass. Grunvald says there’s a fourth procedure – biliopancreatic diversion with duodenal switch, but it’s used in only 2 percent of bariatric procedures.
Gastric Band
In this type of surgery, a band is placed around the top of your stomach to create a small pouch. This procedure makes you feel full after eating a small amount of food. Remission of diabetes occurs in approximately 45-60 percent of patients who undergo this procedure.
Sleeve Gastrectomy
Grundvald describes the sleeve gastrectomy as being an anatomically simpler procedure than gastric bypass. “In gastric sleeve surgery about 80 percent of the stomach is removed, leaving a long banana shaped section,” says Grunewald. This surgery reduces the amount of food that can fit in your stomach, making you feel full sooner. Diabetes remission rates after sleeve gastrectomy are more than 60 percent.
Gastric bypass
This surgery is like changing your plumbing says Grundvald. Gastric bypass alters the gastrointestinal tract causing food to bypass most of the stomach and upper portion of the small intestine. The surgeon staples the top part of the stomach, creating a small pouch and attaching it to the middle part of the small intestine. Remission of diabetes occurs in 80 percent of patients.
Duodenal Switch
This surgery, also called biliopancreatic diversion with duodenal switch, is more complex than the others. The duodenal switch involves two separate surgeries. The first is similar to gastric sleeve surgery. The second surgery redirects food to bypass most of your small intestine. The surgeon also re-attaches the bypassed section to the last part of the small intestine. Diabetes remission rates are 85 percent.
If you are overweight or obese with type 2 diabetes, metabolic surgery may be a treatment option for you. Your doctor will use a number of factors—including how long you’ve had diabetes, to determine which type of metabolic surgery is best for you.
To learn more, Dr. Shaneeta Johnson of Morehouse School of Medicine explains weight loss surgery for diabetes in the video below.
https://www.facebook.com/BlackDoctor.org/videos/10154287443191194/
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