Can Bariatric Surgery/Gastric Bypass Surgery Cure Diabetes?

Can You Reverse Diabetes With Gastric Bypass Surgery?

Bariatric surgery can be a very good alternative when dietary and medication approaches fail for diabetes type 2. Bariatric surgery has been a popular treatment for obesity treatment recently for this reason. Can bariatric surgery cure diabetes? Sometimes but not all cases.

Patients having a milder form of diabetes (controlled with diet) for less than five years, and who achieve greater weight loss after surgery, are more likely to achieve complete resolution of diabetes mellitus.

What is bariatric/gastric bypass surgery?

Can gastric bypass diabetes remission?

When it comes to diabetes cure or diabetes remission Roux-en-Y gastric bypasses are the gold standard type of bariatric surgery. Surgeons reroute the food to skip part of the stomach and the beginning of the small intestine. Bariatric surgery can help cure diabetes, high blood pressure, severe joint pains, even infertility, and numerous other disorders. Bariatric surgery changes the anatomy of your intestines to help you lose weight.

Weight loss surgery typically results in greater and sustained weight loss than traditional treatment. Bariatric surgery also leads to improvements in quality of life and obesity-related complications such as diabetes, hypertension, sleep apnea, and, orthopedic problems.

What are the criteria to be eligible?

Before the patient can become eligible for bariatric surgery, the following criteria must be met. First of all, the patient understands the basics of the operation, benefits, and risks during and following the surgical operation. In addition to that patients have to meet the following criteria:

• Body mass index (BMI) of 40 or more, which is about 45 kg (100 pounds) overweight for men and 35 kg (80 pounds) for women; or

• BMI between 35 and 39.9 and a serious obesity-related health problem such as type 2 diabetes, heart disease, or severe sleep apnea. As you know, the majority of patients with type 2 diabetes are obese. For obese diabetic patients who fail lifestyle management and only available medical treatments, bariatric surgery may be an effective treatment alternative.

We see long-term diabetes remission in 23 to 60 percent of patients, depending on the baseline severity and duration of their diabetes. A recent study on over 20,000 patients showed that 84 percent who underwent Roux-en-Y gastric bypass (RYGB) experienced a complete reversal of their type 2 diabetes.

Effective bariatric surgery on blood sugars following the operation can be visible within a few days. Some theories explain are with a significant increase in hormone release from the gastrointestinal system.

Can gastric bypass surgery help prevent diabetes in obese patients?

Gastric bypass causes significant weight loss that can help cure diabetes in some cases.

International surveying in France, of 300,000 very obese patients between 2008 and 2016 showed that 100,000 of those 300,000 patients who underwent bariatric surgery were 6 times less likely to develop type 2 diabetes. They were also much less likely to develop type 2 diabetes complications.

Overall, bariatric surgery decreased HbA1c by 2 to 3.5 percent, compared with 1 to 1.5 percent with regular medical treatment. Most trials also favored surgery in secondary endpoints such as weight loss and remission of metabolic syndrome. Is bariatric surgery very effective for a mildly obese patient? Almost all trials also included patients with BMIs between 30 and 35 kg/m2 showed that patients with lobar BMIs benefited from the surgery as well as very high BMIs such as those above 40.

Almost 20 observational studies with one to three years of follow-up reported a diabetes remission rate of 78 percent and an improvement rate of 87 percent for type 2 diabetes with a one- to three-year follow-up.

Does remission from diabetes last?

The durability of diabetes remission after bariatric procedures has been another subject of debate. In a study performed in multiple centers, diabetes remission rates at seven years were 60.2 percent. This is a significant number of people nondiabetic for so many years.

Does bariatric surgery prevent heart attacks and strokes? As we all know heart attacks and strokes are the major reasons for mortality in patients with type 2 diabetes. The positive effect of the surgery has been shown in multiple trials.

A lot of retrospective studies indicate that there may be up to 50% reduction in the risk of heart attacks in the following years after bariatric surgery. As you can imagine the frequency of diabetes complications such as kidney disease, diabetic eye disease, and neuropathy was 2-3 times less likely in diabetics who underwent bariatric surgery.

What are the complications or side effects of gastric bypass surgery?

Roux-en-Y gastric bypass complications are diverse and include gastric distension, narrowing of the stomach opening, ulcer formation, gallstone formation, hernias, small bowel obstructions, low blood sugar if on insulin or sulfonylurea drugs (glipizide, glyburide, glimepiride), dumping syndrome, metabolic and nutritional deficiencies, and weight regain.

Some complications are seen soon after surgery while others may present weeks to months or even years following the surgery. Ahmet Ergin, MD, FACE, CDCES, ECNU Endocrinology