Bariatric Surgery for Diabetes
A large number of women and men suffering from obesity are diagnosed with diabetes every year. Fortunately, in many cases, the disease goes into remission or the patient achieves sustainable symptomatic relief after weight loss surgery. This has led researchers to explore the correlation between bariatric surgery and diabetes. Scientific evidence now overwhelmingly suggests that bariatric surgery for diabetes may be a definitive solution for eligible patients with this condition.

 

What is bariatric metabolic surgery

When bariatric surgery for diabetes is performed on a patient with a dual aim to eliminate obesity and disease control, it is called bariatric metabolic surgery (baros = weight). Metabolic adjustment through operative manipulation is one of the key elements in a weight loss surgery that helps in improving obesity-related co-morbidities such as diabetes.

Types of metabolic surgery

When your weight loss surgeon establishes bariatric surgery and diabetes are correlated in your case, they may recommend one of the three primary forms of metabolic surgeries. These include: gastric bypass surgery, gastric sleeve surgery, and duodenal switch surgery. Even gastric band surgery may work in some cases. All these surgical interventions could create the desired metabolic changes to improve diabetes symptoms.

How metabolic surgery works

Many patients want to know how does bariatric surgery improve diabetes, or which weight loss surgery is best for diabetes. Research is still continuing to under the exact nature of the biological mechanisms that elicit remission or full resolution of diabetes through metabolic surgery. But patient outcomes show that diabetes control occurs in proportion to the amount of weight loss achieved through a metabolic surgery.

Bariatric surgery and type 2 diabetes: What’s the connection?

It is a valid question to ask your surgeon during your pre-op consultation that why does bariatric surgery cure diabetes. In particular, researchers have found a substantial amount of evidence that shows that type 2 diabetes mellitus (T2DM) and bariatric surgery have a clear connection.

  • Gastrointestinal illness: Medical community now considers type 2 diabetes as a gastrointestinal disease, which is treatable with gastrointestinal surgery. When a gastrointestinal surgery is undertaken to address morbid obesity, it is termed as bariatric metabolic surgery.
  • Surgical approach: Once it is established that bariatric surgery and type 2 diabetes are correlated in your case, your bariatric surgeon may recommend a restrictive and malabsorptive surgery (gastric bypass), restrictive surgery (VSG), or a biliopancreatic diversion surgery with a duodenal switch.
  • Gut microbiota: Changes in the composition of gut microbiota may contribute to your condition of obesity and type 2 diabetes. Bariatric surgery for diabetes will reduce gut permeability and reverse the metabolic inflammation in the gut to help in correction of the disease symptoms.
  • Bile acids: Changes to bile acid metabolism can increase lipid absorption and alter the glucose metabolism, leading to type 2 diabetes, insulin resistance, and metabolic syndrome. Bariatric surgery and type 2 diabetes are connected because this surgery will correct the bile acid metabolism.

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Bariatric surgery cures type 2 diabetes: Myth or Fact?

It is a fact that bariatric surgery for diabetes is the single most effective mechanism for type 2 diabetes remission. Researchers have mounting evidence to show how does bariatric surgery improve diabetes type 2, but they are reluctant to term it as a cure in every case.

  • Research study I: Can gastric sleeve cure diabetes type 2? To determine the answer to this complex question, researchers studied the results of 72 patients who had type 2 diabetes and received a VSG surgery. It was found that the patients achieved significant enhancement of glycemic control levels. [Google Scholar]
  • Research study II: To establish the favorable relationship between gastric bypass and diabetes type 2, researchers investigated patients who underwent a gastric bypass surgery. Results showed diabetes remission in approximately 60% of the patients after a laparoscopic gastric bypass. [Google Scholar]
  • Research study III: To demonstrate why does bariatric surgery cure diabetes type 2 even in non-obese patients (with a BMI of less than 30), researchers evaluated 21 studies involving over 900 patients. They found that non-obese patients can achieve normal lipid and glucose levels post-surgery. [Google Scholar]

Type 1 diabetes and bariatric surgery

With the alarming growth in obesity in the US in recent decades, researchers have identified an increasing trend of morbidly obese patients with symptoms of type 1 diabetes. Therefore, bariatric surgery type 1 diabetes has become a subject of critical research and investigation.

Gastric bypass and diabetes type 1

Although the relationship between bariatric surgery and diabetes type 2 has been long established, the research regarding its benefits for type 1 diabetes mellitus (T1DM) is still limited. However, in a 2004 study, researchers first noted improvement in T1DM in a patient who received a gastric bypass surgery. [PubMed]

Type 1 diabetes and gastric sleeve surgery

Bariatric surgery for diabetes type 1 was evaluated in greater depth in a research study involving six patients diagnosed with this condition. Three of these patients underwent gastric sleeve and the remaining three had a gastric bypass. Daily insulin dependence reduced in all six patients post-surgery. [PubMed]

How does bariatric surgery reverse diabetes

Can bariatric surgery cure diabetes? Researchers have established a growing body of evidence over the years to show that weight loss surgery treats type 2 diabetes in patients with a BMI of 35 or above. For a patient it is important to understand how does bariatric surgery reverse diabetes?

  • Glycemic control: Bariatric surgery for diabetes works in multiple ways to restore your body’s glycemic control. These include a combination of lower consumption of calories, a natural increase in the secretion of insulin hormone, and an increased level of insulin sensitivity in the body.
  • Fat reduction: Obesity results in accumulation of excess fatty cells in the liver, muscles and abdomen, which increase the adipocyte cyctokines and free fatty acid levels. These factors promote insulin resistance. Bariatric surgery reduces these factors, helping in improved insulin regulation.
  • Glucose homeostasis: Better diet management and regular exercise following a bariatric surgery improve the balance of glucagon and insulin in the body to maintain healthy levels of blood glucose. This process called glucose homeostasis helps in diabetes reversal after bariatric surgery.

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Diabetes and gastric sleeve surgery

Can gastric sleeve cure diabetes? The good news is that a sleeve gastrectomy may produce similar benefits for the remission or resolution of diabetes symptoms as other more invasive bariatric surgeries. A comprehensive 10-year research study now supports a correlation between diabetes and gastric sleeve surgery. Here are some of the study highlights.

  • In initial remission diabetes, gastric sleeve surgery may have identical or even superior results than gastric bypass.
  • More than 83% of the participants in the study reported a remission of diabetes symptoms within five years.
  • More than 56% of the participants in the study reported a remission of diabetes symptoms within one year.
  • 42% of the patients reported a relapse of diabetes symptoms within 5 years after gastric sleeve (compared to 33% for gastric bypass).
  • Researchers said that gastric sleeve surgery and diabetes correlation shows it could be a treatment option for eligible candidates.

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Gastric bypass and diabetes

Gastric bypass is considered the gold standard in bariatric surgery or diabetes patients. Extensive medical research is available to demonstrate a positive relationship between gastric bypass and diabetes. If you ask your surgeon which weight loss surgery is best for diabetes, chances are they may recommend a gastric bypass for you. Here are a few key insights:

  • Gastric bypass reduces nutrient absorption in the small intestine, enabling elimination of excess glucose.
  • Improved blood sugar regulation occurs because the small intestine produces GLUT-1 molecule after the gastric bypass surgery.
  • Stomach is bypassed for food and the mechanical stress caused by direct delivery of food to the intestine triggers metabolic changes.
  • Gastric bypass and diabetes have a stronger correlation because unlike VSG, gastric bypass is a malabsorptive surgery.
  • RYGB bariatric surgery for diabetes starts working to resolve symptoms even before you actually begin losing weight.

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Lap band and diabetes type 2

Adjustable gastric band surgery, commonly known as lap band, is a relatively less invasive procedure to treat obesity. While medical evidence is scarce and controversial about whether lap band diabetes type 2 are correlated, one study has supported this contention. Here are the highlights of this study.

  • The study evaluated 60 patients diagnosed with type 2 diabetes who either received medical treatment or lap band surgery.
  • At two years, 73% of patients in the surgery group achieved remission of type 2 diabetes after lap band.
  • At two years, only 13% of the patients in the non-surgical intervention group achieved diabetes remission.
  • Surgical patients achieved significant weight loss, which was directly associated with lap band and diabetes remission.
  • The findings of the study remain controversial because the medical treatment group may not have been given aggressive treatments.

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Risks of bariatric surgery for diabetes

While it is important to understand how does bariatric surgery reverse diabetes, you should also ask your surgeon what are the risks involved? A dedicated weight loss surgeon will carefully evaluate your risk factors and recommend bariatric surgery for diabetes only if the benefits significantly outweigh the risks in your case. Here are some of the notable issues regarding the risks of bariatric surgery for diabetes patients.

  • The rate of mortality and morbidity is higher for diabetes patients after a bariatric surgery compared to non-diabetics.
  • Diabetes reduces the body’s ability to heal, which can become a risk factor for anastomotic leakage after bariatric surgery.
  • Risks of bariatric surgery for diabetes will vary according to the type of surgery performed (VSG will have lower risk of bowel disorders).
  • Risk of nutrition deficiency may be higher for gastric bypass and diabetes because it is a malabsorptive procedure.
  • In most cases, the health benefits of weight loss surgery for diabetes patients substantially outweigh the risk of complications.

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Post bariatric surgery hypoglycemia

Hypoglycemia is a condition where the glucose level in the body drops below normal. Post-bariatric surgery hypoglycemia (PHB) occurs more commonly within a few hours after a meal. The severity of the symptoms may be higher if you have consumed a higher quantity of carbohydrates (with a high glycemic index) that what is prescribed in your post-op bariatric diet plan. Sometimes, this condition may also occur after you have performed aggressive physical activities or exercise.

Hypoglycemia after gastric bypass

Hypoglycemia after gastric bypass may be triggered either due to insulin or non-insulin dependent factors. Following a gastric bypass surgery, a significant portion of the food will bypass the stomach and enter directly into the small intestine. This can stimulate over-production of insulin, which leads to rapid decline in glucose levels. As a result, you may experience the symptoms of hypoglycemia after gastric bypass, especially if you do not eat controlled meal portions or eat without chewing well.

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Reactive hypoglycemia after gastric sleeve

Reactive hypoglycemia after gastric sleeve surgery is a relatively less common complication. However, it is important to be alert to this condition if you have had bariatric surgery for diabetes. Insulin independent uptake of glucose, diminished insulin clearance in the body, and heightened glucose sensitivity of the beta cells in your pancreas may contribute to the symptoms of reactive hypoglycemia after gastric sleeve. Treatment may involve a combination of medications and adjustments to your diet.

Verdict: Which weight loss surgery is best for diabetes

In general, gastric bypass and diabetes have the highest positive correlation, which makes this weight loss surgery the best for diabetes patients. However, in a few cases, surgeons may consider diabetes and gastric sleeve surgery to have a stronger correlation depending on the patient’s BMI, severity of pre-op diabetes, and other factors. In almost all circumstances, bariatric surgery for diabetes is a proven solution.