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Metabolic Surgery
Metabolic Surgery for Diabetes – What the latest research tells us.

Approximately 90 percent of all diabetics in the word are type 2 diabetics.

In this form of diabetes, the body does not produce enough of the hormone insulin, or the cells in the body do not use insulin properly. Insulin is necessary for the body to be able to use glucose or blood sugar for energy. As a result, glucose builds up in the blood, where it can wreak havoc, instead of going into cells. Complications of diabetes include heart disease, blindness, nerve damage and kidney damage.

Type 2 diabetes is the form of the disease most closely linked to obesity and the name Diabesity has been used to describe this association.

Traditionally, lifestyle changes including losing excess weight, eating a healthful diet and engaging in regular exercise are the first-line treatments for type 2 diabetes. When these modifications do not make enough of a dent in the disease, medications can be prescribed. Some medications help the pancreas produce more insulin, while others help the body use the insulin that it does produce more efficiently. If these drugs don’t work, a person may need to take insulin.

Often these traditional treatments for diabetes do not work and patients run the risks of long term complications. These include:

1. Diabetic Retinopathy – the leading cause of blindness in adults.
2. Diabetic Nephropathy – the leading cause of kidney failure in adults.
3. Diabetic Neuropathy – leading cause of non-traumatic amputations of the lower extremities in adults.
4. Cardiovascular disease – 8/10 patients with type 2 diabetes die of cardiovascular disease.
5. Stroke – 2 to 4 times more likely to have a stroke.

Even with good medical control, some patients still go on dialysis, lose limbs, and have significant heart attacks, drug reactions and other complications. The notion that medical therapy is without risk is absolutely incorrect.

More than 30 scientific studies say yes!

To be crystal clear, diabetes is poorly understood and medical science cannot claim a “Cure”. The aim is to put it in remission, defined as normal blood sugar levels and no need for diabetes medication. This means bringing glucose to normal levels and arresting the progression of the diabetic complications, thus giving the body a chance to repair the damage.

One recent study in the Journal of the American Medical Association (JAMA) found that 73 percent of people with diabetes who underwent gastric banding combined with conventional therapy achieved remission. By contrast, just 13 percent of those people who received only conventional therapy went into remission.

A landmark 2004 study in JAMA of more than 22,000 people who underwent bariatric surgery showed the following:

1. Diabetes was completely resolved or improved in 86% of patients.
2. High blood lipids improved in 70% or more of patients.
3. High blood pressure was resolved or improved in 78% of patients.
What’s more, a study in the Annals of Surgery showed that 83 percent of 240 people who underwent gastric bypass were “cured” of their diabetes.

A study in the New England Journal of Medicine found that long-term mortality after gastric bypass surgery was significantly reduced, particularly deaths from diabetes.

The bottom line is that metabolic surgery can play a big role in treating Type 2 diabetes.

We know that metabolic surgery puts type 2 diabetes into remission; what we don’t know is how it does it.

Some theories do exist, including the idea that shunting food directly to the lower intestine stimulates a substance called glucagon-like peptide 1 (GLP-1) , which can increase insulin production.

Another theory suggests that hormones that prompt hunger such as peptide Y (PPY) may be dulled by rearranging the anatomy of the gut, so if they crave less sugar, people may be able to manage their blood sugar levels better.

We also do not know the ideal type of metabolic surgery for treating diabetes. Studies have looked at different types of surgeries. Until the right one is found, the laparoscopic RY gastric bypass is the one that works well and puts type 2 diabetes into remission almost immediately after the surgery.

Another question that remains is when, should the surgery be performed — when diabetes is first diagnosed or down the road, when complications have already begun to arise? Intuitively, the sooner the better to prevent the complications of type 2 diabetes.

Actually, 2/3 of the world’s type 2 diabetics are not morbidly obese. They are however, overweight with BMI range 27-35.

Most metabolic surgeons with a lot of experience (that means they can perform the laparoscopic gastric bypass with very low complication rate), including Dr. Christou, will accept patients with type 2 diabetes and BMI of 30 or greater for metabolic surgery.

It is possible that metabolic surgery may benefit even people with diabetes who are not overweight or obese. Use of experimental procedures as well as conventional bariatric operations is increasingly being explored in less obese diabetic patients, with generally favourable results, although further assessment of risk to benefit profiles is needed.

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