Type 2 diabetes is a leading cause of disease and death in the United States. As diabetes develops in overweight individuals, the most successful treatment options for diabetes involve weight loss. Although the relationship between bariatric surgery and diabetes is still being understood, bariatric surgery has shown to be a treatment option for obese patients with diabetes.

Fast Facts About Diabetes:

• Approximately 90% of cases of Type 2 Diabetes Mellitus are due to excess body fat.
• Diabetes is one of the top ten leading causes of death in the United States.
• People with diabetes spend 2x more money on health expenses than non-diabetics.
• Obesity is the leading risk factor for developing Type 2 diabetes.
• Weight loss is a crucial component of managing diabetes.
• Metabolic and bariatric surgery is one of the most effective forms of treatment among obese individuals with Type 2 diabetes.

What is diabetes?

Diabetes mellitus is a group of metabolic diseases that affect the way your body utilizes blood glucose (or blood sugar). Diabetes is a disease where there is excessive blood sugar in your bloodstream, which has harmful effects on your tissues over time. Chronic diabetes is divided into two categories: Type 1 and Type 2. Type 1 diabetes is an autoimmune disorder of the pancreas and is usually diagnosed in childhood or early adulthood. Type 1 diabetes accounts for about 5% of the population living with diabetes. Type 2 diabetes is the most prevalent form of diabetes, accounting for about 95% of the diabetic population.

Type 2 diabetes is frequently diagnosed in individuals over age 45. Recently, it is becoming more prevalent among younger people. In Type 2 diabetes, your cells do not respond typically to insulin. Insulin is a hormone secreted by the pancreas that helps cells in your body absorb sugars from carbohydrates. These sugars act as energy sources for the cell and can also be stored for future energy needs. When you have too much sugar in your bloodstream, your pancreas overproduces insulin, which creates insulin resistance over time. Because your body no longer responds appropriately to insulin, your blood sugar rises. Sustained elevated blood sugar levels lead to organ and tissue damage.

Risk of Type 2 Diabetes

You are at higher risk for Type 2 diabetes if you:

• Have Prediabetes
• Have excess body weight
• Are 45 years of age or older (although more and more young people are being diagnosed)
• Are physically inactive
• Have ever had gestational diabetes (diabetes with pregnancy)
• Have an immediate family member with Type 2 diabetes (brother, sister, parent)
• Are African American, Hispanic/Latino, American Indian, or Alaska Native

How Does Obesity Cause Diabetes?

Studies have revealed that the prevalence of diabetes is 20 times higher in obese individuals with a BMI greater than 35kg/m 2. While the relationship between obesity and diabetes is complex, and there are many questions yet to be answered, research shows that obesity impairs glucose regulation. Fat deposits throughout the body, particularly in the abdomen, cause insulin resistance. Inactivity and poor diet further the development of insulin resistance. Although there is much to be learned at the cellular level of how excess weight causes diabetes, we do know that weight loss is the primary treatment of diabetes.

Weight Loss Can Treat Diabetes

Weight loss is necessary for overweight patients with diabetes. Research shows that sustained weight loss of 5-10% of total body weight can decrease fasting blood sugar, improve the effects of insulin in the body, and reduce the need for medication. Diabetes can be treated through a program of lifestyle and behavioral modification. These modifications include prevention, diet, exercise, medicine, and bariatric surgery.

•  Prevention - Prevention is the key to diabetes. Teaching healthy lifestyle habits, such as diet and physical activity at an early age, can significantly decrease the risk for diabetes in adulthood. Adults that are at risk for diabetes or are prediabetic should know that diet and lifestyle changes can prevent diabetes.

•  Diet - Calorie counting is critical for effective weight loss. The amount of energy (or calories) you take in should be less than the amount of energy you are expending.

•  Exercise - Regular physical activity helps with weight loss and can increase insulin sensitivity. Moderate physical activity should be done at least five times throughout the week.

•  Medication - There are many different types of medication to treat prediabetes, diabetes, and obesity. Your provider may recommend medication to you depending on the severity of your diabetic state.

•  Bariatric Surgery - The relationship between weight loss surgery and diabetes is being heavily studied. Because patients lose more weight with bariatric surgery than with traditional weight loss methods, surgery is an effective treatment.

Does Weight Loss Surgery Cure Diabetes?

Studies have demonstrated that nearly 90% of weight loss surgery patients found improvement in their diabetic condition. These improvements showed that patients had lower blood sugars, a decrease in the dose and type of medication needed, and improvement in related health problems. Studies have also found that 78% of Type 2 diabetic patients had complete remission of their disease with bariatric surgery. This was evidenced by normal blood sugar levels and no need for medication post-surgery.

So, can bariatric surgery cure diabetes? Unfortunately, weight loss surgery is not the end-all-be-all cure for diabetes. Instead, experts say that weight loss surgery can put diabetes into remission. Remission means that symptoms of the disease have disappeared and are not currently placing the patient at risk of other illnesses. Remission occurs after bariatric surgery because of significant weight loss. Therefore, a weight loss surgery patient is at risk for diabetes if they re-gain weight. In a small number of cases, a reoccurrence of diabetes has happened for unknown reasons.

What Are The Success Rates For Different Bariatric Surgeries?

There are different types of bariatric surgery that can treat morbid obesity and diabetes. The following procedures are the most common bariatric surgeries performed in the United States:

•  Roux-en-Y Gastric Bypass: This bariatric surgery alters the digestive tract so that food bypasses the majority of the stomach and the upper part of the small intestine. Because the surgical changes limit food absorption, patients have significant weight loss. The resulting weight loss, as well as changes in gut hormones, causes remission of diabetes in 80% of gastric bypass patients. There is also significant improvement (but not remission) of diabetes in an additional 15% of patients.

•  Sleeve Gastrectomy: This weight loss surgery is useful because a large portion of the stomach is removed. Therefore, patients who undergo gastric sleeve surgery cannot eat as much food as there is not enough space to hold a large bulk of the food. Greater than 60% of patients who undergo gastric sleeve surgery have remission of their diabetes. Furthermore, because part of the stomach is removed, gut hormone changes have also shown to improve glucose metabolism. These changes are unrelated to weight loss but rather are due to a change in digestive anatomy.

•  Adjustable Gastric Band (or Lap-Band): This procedure involves a surgeon placing an inflatable silicone band around the upper portion of the stomach. The group creates a small pouch for food, which slows and limits the digestion of nutrients. Studies of Type 2 diabetes and lap band surgery show that remission occurs in 45-60% of patients. However, remission or improvement in diabetes is only related to weight loss rather than changes in gut hormone activity.

•  Duodenal Switch: This is a hypoabsorptive weight loss surgery that combines a gastric sleeve and intestinal bypass. This highly complex procedure changes the digestive anatomy so that food absorption is extremely reduced. Therefore, patients who undergo this surgery lose between 70-90% of their excess weight. Because of the significant weight loss from this surgery, studies have shown that it is the most effective weight loss surgery in early and sustained remission of diabetes. That is, 85%-95% of patients will experience remission.

Bariatric Surgery Treats Diabetes, So Is Weight Loss Surgery A Treatment Option For Me?

Every year, millions of people die from Type 2 diabetes and its complications. With incredible advancements in bariatric surgery, weight loss surgery can save and improve many lives. When other methods of weight loss have failed, surgery may be the best option for diabetes management. Although there are risks with bariatric surgery, the risk of long-term diabetes and its associated diseases (stroke, heart disease, kidney failure, etc.) is far greater. Furthermore, as diabetes can be poorly managed with medication long term, bariatric surgery can put diabetes in remission.

Each individual is unique. Thus, the severity and duration of each person’s diabetic state must be evaluated along with their obesity-related medical problems to determine whether or not bariatric surgery is an option. Schedule an appointment with your health provider to see if bariatric surgery is a treatment option for your diabetes.