Bariatric surgery and its impact on type 2 diabetes: Comprehending the dangers and benefits
Bariatric Surgery Offers Long-term Benefits for Type 2 Diabetes Management
Bariatric surgery is increasingly being recommended as a treatment option for individuals with type 2 diabetes and obesity. This weight loss procedure has been shown to offer significant long-term benefits, including substantial and sustained weight loss, improved glycemic control, and a high rate of diabetes remission.
Weight Loss and Diabetes Remission
Bariatric surgery typically yields much greater long-term weight loss than medical management or weight loss medications. For example, surgery patients often lose about 25-26% of their total body weight, compared to around 5-8% with medications over two years. Among surgical procedures, Roux-en-Y gastric bypass (RYGB) has shown greater excess weight loss (EWL) and total weight loss (TWL) compared to sleeve gastrectomy (SG) over 5+ years of follow-up.
Surgery significantly improves glycemic control, often leading to partial or complete remission of type 2 diabetes. At 12 years post-surgery, about 54% of patients maintain HbA1c below 7% without diabetes medications, compared to 27% with medical/lifestyle therapy alone.
Reduction in Cardiovascular and Metabolic Risks
Bariatric surgery not only improves blood sugar but also reduces other obesity-related conditions such as hypertension, dyslipidemia, and nonalcoholic fatty liver disease.
Potential Complications and Limitations
Despite its benefits, bariatric surgery is associated with potential complications that warrant consideration. Surgical risks and nutrient absorption issues may lead to vitamin/mineral deficiencies and the need for lifelong supplementation. Postoperative complications include surgical site infections, leaks, strictures, or need for reoperation, though rates vary by procedure.
Not all patients achieve lasting diabetes remission, and some may require ongoing medical therapy. HbA1c can be a less reliable marker during early postoperative recovery because it does not reflect real-time glycemic fluctuations.
The benefits of surgery seem to be best-established in those with a BMI of 35 or higher. The risk of death within 30 days of bariatric surgery is approximately 0.16%, according to the American Society for Metabolic and Bariatric Surgery.
Lifestyle Management and Follow-up
Regular follow-up visits are necessary in the long term to monitor a person's weight and look for signs of potential complications such as vitamin deficiencies. The greatest benefits seem to be in people who continue to adhere to a healthy, low calorie diet, get regular physical activity, and attend regular follow-up appointments with their doctor.
Before choosing bariatric surgery to treat type 2 diabetes, a person must commit to lifelong maintenance of diet, exercise, and regular healthcare visits. It's important to note that healthcare professionals typically ask people to try other weight loss methods before considering bariatric surgery.
Types of Bariatric Surgery
Two common types of bariatric surgery are vertical sleeve gastrectomy and gastric bypass (Roux-en-Y). Vertical sleeve gastrectomy permanently removes about 80% of the stomach to leave a long pouch. Gastric bypass (Roux-en-Y) is a more complex procedure where the top part of the stomach is stapled off, leaving a pouch that can hold about an ounce of food.
Side effects following bariatric surgery may include gallstones, hernias, narrowing of the new stomach or the connection between the stomach and the small intestine (strictures), and an inability to absorb enough nutrients, which can lead to anemia and osteoporosis. For some people, bariatric surgery may not produce the expected results, and a person should contact their doctor right away if they are not losing weight or if they develop complications following the procedure.
In summary, bariatric surgery offers superior long-term outcomes compared to medical or lifestyle management for obese individuals with type 2 diabetes by substantially reducing weight and improving or even resolving diabetes. This benefit, however, must be weighed against surgical risks, the need for lifelong follow-up, and variable durability of diabetes remission depending on individual factors and the type of surgery performed.
- Bariatric surgery is often recommended for individuals with type 2 diabetes and obesity as it provides significant long-term benefits, including weight loss, improved glycemic control, and diabetes remission.
- Roux-en-Y gastric bypass (RYGB) has shown greater excess weight loss (EWL) and total weight loss (TWL) compared to sleeve gastrectomy (SG) over 5+ years.
- Surgical procedures like bariatric surgery not only improve blood sugar levels but also reduce other health issues such as hypertension, dyslipidemia, and nonalcoholic fatty liver disease.
- Despite potential complications like vitamin/mineral deficiencies and postoperative issues, bariatric surgery holds the promise of long-term benefits for those with a BMI of 35 or higher.
- Regular follow-ups are necessary to monitor weight and check for potential complications, and the greatest benefits often come from those who maintain a healthy diet, exercise regularly, and attend regular appointments.
- Two common types of bariatric surgery are vertical sleeve gastrectomy and gastric bypass (Roux-en-Y), each with its own set of potential side effects.
- Bariatric surgery can be a valuable treatment option for obese individuals with type 2 diabetes, but it requires a lifelong commitment to healthy lifestyle changes and regular medical care.
