According to the World Health Organization, type 2 diabetes was the 7th deadliest disease in the world in 2016. In the United States, diabetes was accountable for 3% of total deaths during that year. Estimates in Mexico were so much worse, where this disease caused 15% of total deaths. There’s a high prevalence of diabetes in both countries. It has been reported that, by 2014, at least 9% of Americans and 10% of Mexicans were suffering from this condition.
Obesity, a major risk factor for diabetes, is also on the rise and its numbers are cause for serious concern. According to the National Center of Health Statistics, in 2017-2018, 42.4% of the American adult population and 21% of the teenage population was obese. Projections of the World Health Organization estimate that in just 5 years, Mexico might be reaching roughly the same numbers. This is definitely a public health issue.
Just 10 years ago, the resolution of type 2 diabetes was considered a fortunate outcome of bariatric surgery. However, recent research indicates that weight loss surgery can cure diabetes, even much more than long term medical management and lifestyle intervention programs involving diets, exercise and behavioral changes. As more and more randomized control trials confirm this, bariatric surgery is now considered an effective treatment against type 2 diabetes in obese patients. The 2nd Diabetes Surgery Summit recognized that weight loss surgery can cure diabetes and it recommended it as treatment for diabetic patients with a body mass index (BMI) of 40 or higher. It also recommended it in patients with a BMI of 35-39.9 when high glucose cannot be controlled with healthy lifestyle habits and medications, and in patients with 30-34.9 BMI when high glucose remains uncontrolled even with medications.
Circumstances under which weight loss surgery can cure diabetes
When we say that weight loss surgery can cure diabetes, we mean to say that it usually leads to the discontinuation of all diabetes-related medications and to the reduction of blood glucose to normal levels. This outcome is achieved way more frequently after treatment with bariatric surgery, than after treatment with lifestyle intervention programs for obesity. Studies report that lifestyle intervention programs by themselves have a failure rate of 95% at 1 year. In contrast, bariatric surgeries accomplish the reduction of euglycemia and insulin levels, in just days after the procedure, even before there’s any weight loss.
Some types of weight loss surgery can cure diabetes at a higher chance than others. It also depends on the patient’s life factors, such as his or her BMI, the amount of weight loss during the first post-operation year, and the success in adopting and maintaining a healthy lifestyle.
By far, the Roux-en-Y gastric bypass has proven to be the most effective weight loss surgery that can cure diabetes. The second most effective is the biliopancreatic diversion. Although the gastric sleeve has also been proven to ameliorate and reverse diabetes, it does so at a lower percentage than other procedures available. The explanation of this difference comes from the malabsorptive properties of the Roux-en-Y gastric bypass and the biliopancreatic diversion. Malabsorptive surgeries change the metabolic process of patients by shortening the small intestine and attaching it higher in the stomach, which also gets restricted. With the digestive track shortened, the intestines absorb less nutrients and less calories. These changes in the intestinal nutrient-sensing mechanisms might regulate insulin sensitivity too, which greatly benefits diabetes patients.
Restrictive surgeries, like the gastric sleeve, also help with diabetes, but mostly in patients that achieve greater weight loss.
Overweight strongly correlates with diabetes. Patients that lose the most weight after surgery, especially during the first year, are most likely to achieve resolution of type 2 diabetes. But the BMI of the patient also makes a difference. Weight loss surgery can cure diabetes at a higher rate in patients of higher BMI groups. Furthermore, earlier surgery is correlated with higher probabilities of diabetes type 2 remission, in comparison with late interventions.
Of course, bariatric surgery does not accomplish this by itself. A lot of these outcomes depend on the patient’s lifestyle after his surgery. Weight loss surgery can cure diabetes in the long-term if the patient adopts and maintains healthy eating habits and practices frequent exercise. It can even make a difference when a patient relapses from diabetes. A study shows that patients who relapse up to 8 years after their surgery are still better off in comparison of how they were before the surgery. Patients who relapsed after bariatric surgery had better glycemic control and needed less insulin and medications than when they started their treatment.
To find out more about diabetes and the benefits of weight loss surgeries, contact our clinic at Tijuana, Mexico. At LIMARP International Center of Excellence for Obesity, our team experts can help you decide which treatment is the best for you.