Surgery for Treatment of Type 2 Diabetes

05/31/2016

Healthy Living - May 31, 2016
Amy Movius, MD
dr-movius.jpg
Surgery - it’s unnatural. Most of us probable regard surgery in a “last resort” kind of way. The very idea brings up visions of extreme circumstances.  However, an extensive series of articles just released links bariatric - aka “weight-loss” - surgery in patients with Type 2 Diabetes with significantly improved health.
 
The implications of this are huge.  Everyone knows somebody with Type 2 Diabetes (T2D).  In fact, one article referred to T2D as a “pandemic”. Being commonplace doesn’t minimize what a bad, bad actor this disease is.  T2D leads to heart disease, destroys kidneys and eyesight, impairs circulation leading to everything from impotence to amputations and is associated with too many other health problems to list. The personal, medical, and social cost of this disease is overwhelming and devastating. 
 
To make matters worse, T2D is very difficult to treat. Despite new medications and behavioral therapies less than half of patients are able to control their blood sugar enough to reduce their risk of these complications.
 
Which brings us back to new evidence-based guidelines addressing surgery as a component of treatment for this disease. The journal Diabetes Care just published these guidelines as part of an 11 article series describing the supporting data.   It has been endorsed by 45 international professional societies and includes surgeon and non-surgeon health providers alike.
 
Bariatric surgery wasn’t developed specifically for T2D patients; it was developed to help morbidly obese patients who also happen to be at great increase risk of T2D.  In patients with T2D who had “weight-loss” surgery it was noted that there was a positive effect on their blood sugar control that was faster and greater than what could be explained by weight loss alone.  The explanation for this is being very actively investigated.  It seems that the anatomic changes in the gut from surgery result in some secondary changes in the hormone, nutrient metabolism, gut bacteria (microbiome), and neurologic function of these patients.  While the science may be complicated, the result is not:
  • Randomized controlled trials of bariatric surgery in obese T2D patients show improved glucose control and decreased cardiovascular risk compared to patients treated with medication and/or lifestyle interventions.
 The common goal for T2D patients is unchanged; maximizing the opportunity for a healthy and happy life. Of course, people with T2D should still take medications appropriately and continue to commit themselves to healthy lifestyle changes. Providers and scientists should continue to support and guide patients as well as explore prevention and new treatments.  And bariatric surgery may become a more prominent tool to achieve patient goals.