Diabetes & Weight Loss Surgery
Diabetes is a disease in which blood glucose levels are above normal. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesn't make enough insulin or can't use its own insulin as well as it should. This causes sugar to build up in your blood.
Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. Diabetes is the sixth leading cause of death in the United States.
Diabetes and Conservative Therapy
Weight loss should be the primary objective of the treatment of diabetes but it is rarely achieved. Weight gain is the major complication of current medical treatment of diabetes (Metformin, etc.). Unfortunately, weight gain appears to be the price paid for a short term improvement in glucose control creating, for some patients, a downward spiral of diabetes management.
In a study reported in the Journal of the American Medical Association (JAMA) a study group of 4,075 followed for 9 years demonstrated a deterioration of diabetes control with medical monotherapy
The diabetes control regimen consisted of diet, insulin, or Metformin for the group of Type 2 diabetics. Despite adherence to a medical regimen, the disease continued to progress. Specifically, with treatment goals of Fasting Blood Sugar (FBG) below 140 and HbA1C less than 7, the results were:
| 4,075 pts., 9yr follow-up |
FBG <140 |
HbA1C <7 |
| Diet |
8% |
9% |
| Insulin |
42% |
28% |
| Metformin |
24% |
24% |
|
After 3 years blood sugar control deteriorated such that only 50% of patients could be maintained on monotherapy. This decreased to 25% after 9 years.
How Does Weight Loss Surgery Affect Diabetes?
Weight loss from surgery has a documented, positive affect on the management of diabetes. The remission rates vary by type of weight loss surgery and other factors. In a randomized control trial documented in JAMA, diabetic patients (60 total, split into 2 groups of 30 each) with adjustable gastric bands (AGB) had a 73% remission rate as compared with the 13% remission rate for the group undergoing conventional therapy. In addition, the mean weight loss results for the AGB group was 20.7% versus 1.7% for the group prescribed conventional therapy. Diabetes remission for the surgical group was 5.5 times that of the conventional group. It is important to note that the participants were patients with BMIs of 30-39 and had been diagnosed with diabetes for a time period of less than 2 years.
When a diabetic patient has gastric bypass surgery, diabetes remission is documented as occurring before weight loss begins.
Remission Mechanism
Remission rates vary by surgery, length of time as a diabetic and other factors you will discuss with Dr. Srikanth. In summary:
| Surgery Type |
Remission Rate |
Remission Mechanism |
| Gastric Bypass |
84% |
- Bypasses duodenum and proximal jejunum - areas that are efficient in the absorption of carbohydrates.
- Bypassing duodenum may release hormonal factors that improve diabetes control
- Abolition of Ghrelin (hunger hormone) level fluctuation
- Weight loss
|
Adjustable Gastric Band |
48% |
- Primaily by weight loss alone
|
| Sleeve Gastrectomy |
60% |
- Primarily by weight loss
- Removal of approx. 85% of the Ghrelin producing stomach
- Faster transit time with the Sleeve helps deliver nutrients to the distal small intestine may help release hormonal factors (GLP-1, PYY) that improve sugar control
|
| Duodenal Switch |
99% |
- Duodenal exclusion
- Reduction of Ghrelin producing cells by removing 80% of stomach
- Faster delivery of nutrients to the distal small intestine may release hormonal factors (GLP-1, PYY) that improve glycemic control
- Weight loss
|
Early surgical intervention is the key to improving diabetes remission. In a study from the Annals of Surgery (2003):
|
Improved (%)
|
Resolved (%) |
| Number |
33 |
158 |
| Severity of Diabetes |
|
|
| Borderline Diabetics (n=14) |
0 |
100 |
| Diet Controlled (n=32) |
3 |
97 |
| Oral Drug Controlled (n=93) |
13 |
87 |
| On Insulin (n=52) |
38 |
62 |
| Duration as diabetic |
|
|
| < 5 years (n=119) |
5 |
95 |
| 6 - 10 years (n=44) |
25 |
75 |
| > 10 years (n=28) |
46 |
54 |
|
