Role of Bariatric Surgery in the Cure of Diabetes

Dr. Carla Sawan
Assistant Professor of Medicine
Division of Endocrinology, Diabetes, & Metabolism
University of Balamand

In 2013, there was an increase in the prevalence rates of obesity worldwide, ranging between 20-30% of the population.

Overweight is defined as a body mass index (BMI) of 25 to 29.9 kg/m2; obesity is defined as a BMI of ≥30 kg/m2. Severe obesity is defined as a BMI ≥40 kg/m2 (or ≥35 kg/m2 in the presence of comorbidities).

Obesity is associated with a significant increase in mortality and many health risks, including type 2 diabetes mellitus, hypertension, dyslipidemia, and coronary heart disease. The higher the BMI, the greater the risk of morbidity and mortality.

Studies have shown that an initial weight loss of 7% through dieting and physical exercise significantly reduced the rate of progression from pre-diabetes to diabetes over a three-year period.

More interestingly, the surgical treatment of obese patients results in a larger degree of weight loss (20 to 30% after one to two years) and higher remission rates of diabetes than lifestyle and/or pharmacologic therapy alone.

There are several types of bariatric surgeries available, the most common being Roux-en-Y Gastric Bypass, sleeve gastrectomy and gastric banding.

1) WEIGHT LOSS:

Patients undergoing a Roux-en-Y Gastric Bypass (RYGB) or a sleeve gastrectomy (SG) achieve weight loss most rapidly over the first few months, then it continues over the next year and a half until weight loss stabilizes. During the first six months after RYGB, the average weight loss is 4.5 to 7 kg per month. The total weight loss reaches a peak at 12 months postoperatively, averaging 45 to 54 kg.

2) CURE FROM DIABETES:

Bariatric surgical procedures are effective interventions for treating type 2 diabetes. Improvement in blood sugar levels is often evident within days to weeks following the surgery.

In a prospective, longitudinal study that included 28,616 obese diabetic patients, remission or improvement in diabetes at 12 months was achieved in 44% to 83% of patients undergoing bariatric surgery, depending on the procedure.

There was also improvement in hyperstension, obstructive sleep apnea, elevated cholesterol levels, gastroesophageal reflux, and infertility due to polycystic ovarian syndrome in females.

Despite these impressive results, it is worth mentioning the complications of such surgeries, such as the rare need for re-operations and re-hospitalizations. There is some debate as well around the long-term success rates in maintaining weight loss. Some weight regain is typical within two to three years of bariatric procedures, and different bariatric procedures result in different levels of weight loss and corresponding reductions in blood sugar levels.

Therefore, it is recommended that the obese diabetic patient undergoing any form of bariatric surgery keeps a regular long term follow up with the surgeon and the endocrinologist. This follow up ensures maintenance of weight loss and remission of diabetes.

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