Bariatric surgery and diabetes

Obesity and type 2 diabetes together represent a growing public health crisis. Now, more experts consider bariatric surgery a cost-effective treatment option under certain conditions for severely obese people living with type 2 diabetes.

The International Diabetes Federation now recommends that physicians consider bariatric surgery earlier in the treatment process to protect patients against complications from type 2 diabetes, which include hypertension, high cholesterol and severe sleep apnea.

Weight loss is key
Bariatric surgeries help you lose weight by limiting the amount of food you eat and reducing the amount of nutrients and calories your body absorbs.

Losing weight is key for obese people with type 2 diabetes to manage and reverse their diabetes in some cases. A study called the Diabetes Prevention Program found that 30 minutes of daily moderate exercise with a 5- to 10-percent loss of body weight reduces the incidence of type 2 diabetes by 58 percent.

A low-calorie diet can also help, according to a recent study presented at the Radiological Society of North America’s annual meeting. Researchers placed obese patients with type 2 diabetes on a diet of 500 calories a day. After 16 weeks, none of the patients needed insulin and all significantly reduced their body mass index (BMI).

Typically, physicians will consider batriatric surgery only after a patient has tried to lose weight with physical activity and diet.

Gastric bypass
Gastric bypass is the most well-known type of bariatric surgery. The most common gastric bypass procedure, Roux-en-Y, seals off the top of the stomach to form a small pouch the size of a walnut. Then, the small intestine is cut in the middle and connected to the pouch.

With Roux-en-Y, food bypasses most of the stomach and the first section of your small intestine to reduce the body’s absorption of calories and nutrients. This procedure also limits the amount of food a person can eat: while a normal stomach holds about three pints of food, this surgery limits the stomach contents to just one ounce.

Biliopancreatic diversion with duodenal switch is another gastric bypass procedure. It connects the end of the small intestine to the duodenum, which is the section of the small intestine connected to the stomach. About 80 percent of the stomach is removed. Food bypasses most of the intestine, reducing the amount of food eaten and limiting the nutrients absorbed.

Other weight-loss surgeries
Laparoscopic adjustable gastric banding (LAGB) is typically known as “lap band” surgery. The surgeon places an inflatable silicon band around the stomach. The band inflates and compresses the top part of the stomach to limit the amount of food a person can eat. Patients may experience less weight loss with this procedure compared to gastric bypass surgery.

Vertical banded gastroplasty, or “stomach stapling,” seals off the upper portion of the stomach from the lower part. When a person eats, the food goes into the upper pouch and eventually empties into the lower portion of the stomach. People generally see less long-term weight loss with this procedure.

A newer type of weight loss surgery is sleeve gastrectomy, or “vertical sleeve” gastrectomy. This surgery changes the shape of the stomach to resemble a tube. This limits the body’s absorption of calories.

Promising results
Bariatric surgery can lead to long-lasting weight reduction, according to a research paper published in the June 2011 issue of Archives of Surgery.

Researchers found that Roux-en-Y gastric bypass reverses type 2 diabetes by 83 percent. Lap band surgery leads to a 62 percent reversal rate several months following the procedure.

The study found that glycemic control improves “rapidly and completely” after Roux-en-Y gastric bypass surgery, and that both laparoscopic adjustable gastric banding and Roux-en-Y surgeries can improve or cure type 2 diabetes.

Potential complications
Patients can develop serious complications from bariatric surgery. According to Mayo Clinic, complications can include excessive bleeding, infection, reactions to anesthesia, blood clots, lung and breathing problems, leaks in the gastrointestinal system, and sometimes death.

Longer-term complications depend on the type of surgery performed. They can include bowel obstruction, diarrhea, nausea, vomiting, gallstones, hernias, low blood sugar, malnutrition, stomach perforation, and ulcers.

Not for everyone
In general, potential candidates include people considered extremely obese with a BMI of 40 or higher, according to Mayo Clinic. People classified as obese with a BMI of 35 to 39.9 are also possible candidates if they have serious weight related health issues like type 2 diabetes, high blood pressure or severe sleep apnea.

Even then, bariatric surgery is not appropriate for all obese patients with type 2 diabetes.

Patients need to meet strict medical guidelines and screening tests to qualify. Considerations include a patient’s current medical conditions, BMI, lifestyle and eating habits, and past surgeries.

Also, patients must agree to make permanent lifestyle changes after surgery when it comes to eating habits, diet and exercise. They also need to maintain their medical check-up appointments after surgery.

Sources: Mayo Clinic, Archives of Surgery, International Diabetes Federation, Diabetes Prevention Program, Radiological Society of North America

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