GUEST COLUMN: Dr. N Prabhudev
Bengaluru, Feb. 9: Bariatric surgery plays important role in the control and prevention of diabetes: weight loss following gastric bypass in obese non-diabetic patients decreases their likelihood of developing diabetes by 60 percent. Bariatric surgery ameliorates diabetes independently of weight loss, through mechanisms that remain unclear. Weight-loss surgery, also called bariatric surgery, can be done in minimally invasive ways via laparoscopy and can be used to treat Type 2 diabetes.
Can Bariatric surgery be used to treat Diabetes?
Weight-loss surgery can treat type 2 diabetes by managing the level of sugar in the blood. Diabetes is a disease that happens when blood sugar – blood glucose levels are too high. Glucose is able to get into cells because of a hormone called insulin. Insulin is made by the pancreas. If your body does not make insulin or make enough insulin, the glucose cannot get to your cells and so stays in the blood.
People who have obesity have 10 times the risk of developing the Diabetes. Foods that are high in fats and carbohydrates increases fatty acids in the blood and lipid build-up in the liver and muscles. This increases insulin resistance and inflammation. Over time, the pancreas stops making enough insulin.
Who is eligible for bariatric surgery to treat diabetes?
• If you have a BMI of 35 or more with type 2 diabetes and/or
• other illnesses related to excess weight, and have not been able to achieve normal fasting blood sugar of less than 125 mg/dl or HbA1c less than 7 percent,
• In some cases when diabetes is hard to manage, people may be eligible for bariatric surgery even if they have a BMI of less than 35.
Types of Bariatric surgery for treating Diabetes
Laparoscopic Roux-en-Y Gastric Bypass
This procedure involves creating a small stomach pouch. This reduces the amount of food you can eat. The intestine is connected to the new pouch and rerouted. The pouch is connected directly to the lower part of the small intestine. Food bypasses the lower stomach, the first part of the small intestine (duodenum) and some of the second part (jejunum). The changes created during gastric bypass cause changes in the way the gut and the pancreas interact. This affects diabetes management even before weight is lost. Patients generally can return to work within three to four weeks. Gastric bypass is a good surgical option in many patients.
Weight loss and sugar control
A majority of patients lose 50 to 80% of the excess weight during the 18 to 24 months after surgery. However, the effects on blood sugar are immediate (within days) after surgery. People who have this surgery can reduce or eliminate diabetes medications.
In particular, Roux-en-Y surgery is effective at diabetes management. About 33% of these patients do not need diabetes drugs after surgery. Within 2 years of surgery, a total of 85% of patients do not require medication. Their diabetes is in remission.
Complete resolution of diabetes is more common among people who have a form of diabetes that does not require medication and who have had diabetes less than five years. Resolution is also more common among people who have more weight loss after surgery. The benefits extend to high blood pressure and high cholesterol. These factors, which increase the risk of strokes and heart attacks, are also improved and/or resolved after surgery.
Long-term care will also include changes to lifestyle, and especially to diet and exercise. This is because it will be important to manage your weight loss and watch for any vitamin or mineral deficiencies. After surgery, you may work with a dietician.
There are risks with any surgery. Some of the more common risks of bariatric surgery are bleeding, bowel obstructions, malnutrition, dumping syndrome, hernia, and adhesions. Other risks include not losing enough weight or having the weight return.