Bariatric Surgery: Cure or Crutch for Diabetes?

The study of medical science can bring about some interesting discoveries. Often a treatment for one condition proves useful for another. For example, years after aspirin was developed as a pain reliever, it also was found to help prevent heart attacks. And today, many procedures like bariatric surgery that are used for weight control can affect the presence of diabetes. In this case, does it mean that surgery is a cure or crutch?

Understanding bariatric surgery

Weight loss following bariatric surgery occurs due to the changes in the digestive system by limiting intake and/or reducing the absorption of nutrients. The most commonly used bariatric surgery techniques are listed below.

  • Roux-en Y gastric bypass – This procedure involves creating a stomach pouch out of a small portion of the stomach and attaching it directly to the small intestine, bypassing a large part of the stomach and duodenum.
  • Sleeve gastrectomy – Weight is lost following the removal of approximately 85 percent of the stomach, and shaping the remaining stomach into a tube or “sleeve.”
  • Laparoscopic (LAP) adjustable gastric banding –By placing a band around the upper part of the stomach to create a small pouch to hold food, the amount that can be eaten is greatly limited.

Current guidelines recommend consideration of bariatric surgery for individuals with a body mass index >40 or >35 with serious comorbidities related to obesity, such type 2 diabetes.

Potential complications

With any surgery there is an associated risk, and bariatric surgery is no different. This is not a benign procedure and should be taken with great consideration and preparation – medically, nutritionally and psychologically. Even the best bariatric program carries with it some risks. Complications following surgical treatment of severe obesity vary based upon the procedure performed, and can be as high as 40 percent.

Complications that can occur immediately after surgery or even later include:

  • Infection
  • Bleeding
  • Hernia at the surgical site
  • Malabsorption of important vitamins and minerals
  • Postoperative hypoglycemia
  • Change in bowel habits
  • Reflux
  • Failure to lose weight or weight regain

Bariatric surgery and diabetes

Bariatric surgery is certainly not a “cure” for diabetes. And since people with type 2 diabetes range in age, duration with the disease and general health conditions, bariatric surgery is not a “one-size-fits-all” solution. The procedure is only for a very carefully selected group of patients.

Furthermore, a recent study conducted at the University of Texas Southwestern showed that by putting people with type 2 diabetes who did not undergo bariatric surgery on the same postsurgical diet as others who did undergo surgery (i.e., ice chips, clear liquids, etc.), the same, if not better, daily blood glucose numbers were achieved. These results put into question pro-bariatric expert claims that diabetes is dramatically improved immediately after surgery. More likely than not, there is some component of caloric restriction, but hormones of the gut likely play a significant role.

Unfortunately, in regards to long term results, as more surgeries are performed on patients with type 2 diabetes, we are seeing more and more patients in the clinic where bariatric surgery failed to “cure” anything. And the failure to get off medications and/or insulin often creates more complicated issues.

The non-surgical, multicomponent approach of behavioral therapy, dietary changes, increased physical activity and appropriate medications remains the best strategy for type 2 diabetes. At least that is the case until medical science unequivocally proves it otherwise.

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