HOW WEIGHT LOSS SURGERY CAN HELP TYPE 2 DIABETES Weight loss surgery can make a big difference for people with obesity and Type 2 diabetes. For instance, evidence shows that weight loss surgery can slow down or even stop the progression of Type 2 diabetes. For some people blood sugar levels return to normal within days or weeks after surgery, meaning they need less medication or none at all. There is general agreement that gastric sleeve and gastric bypass surgery should be offered as an option for people with Type 2 diabetes and obesity (with body mass index above 35). Dr Jordaan says, “In my experience, after gastric bypass surgery I can typically halve my patient’s dose of insulin and/or tablets by the time they leave the hospital three days later”. What do studies show? The data has been overwhelmingly positive. One long-term study tracked 400 people with Type 2 diabetes for six years after they had weight loss surgery. More than 60 out of every 100 people in the study had their diabetes put into remission by the surgery. Their symptoms disappeared completely and they no longer required medication. They also had better blood pressure, cholesterol and triglyceride levels. Other studies have tracked people who took medicine and made lifestyle changes, such as improved diet and increased physical activity. Typically, only six to eight people out of every 100 achieved a similar improvement in their Type 2 diabetes. Which operation is the best? In terms of diabetes management, not all weight loss surgery is equally effective. A recent analysis of 26 studies involving almost 8,000 patients showed that gastric bypass surgery was more effective for diabetes than gastric sleeve surgery. Out of every 100 people who had gastric bypass surgery, 75 had their diabetes put into remission. Only 60 people out of every hundred achieved the same result after a sleeve gastrectomy. An additional benefit is that people who take less diabetes medication also achieve better weight loss. This is because medication to control diabetes causes weight gain, so reducing the dose improves weight loss following weight loss surgery. Gastric bypass surgery usually refers to the Roux-en-Y gastric bypass, which is considered worldwide as the gold standard for gastric bypass surgery. Another form that is gaining in popularity is known as the Omega-Loop or Mini Gastric bypass. Recent short to medium term studies suggest that it may be a more effective treatment for Type 2 diabetes than the Roux-en-Y gastric bypass, with remission rates of up to around 88%. Long-term data is pending. When is surgery indicated to treat diabetes? Those who have Type 2 diabetes and a body mass index (BMI) above 35 may want to consider bariatric surgery. This is almost a third of our Type 2 diabetics in Australia. Another factor that influences the success rate of surgery is how long a person has had Type 2 diabetes when they have surgery. Those who have had diabetes for less than three years before undergoing weight loss surgery remained in diabetes remission the longest. Controversial research has suggested that even people with Type 2 diabetes who aren't obese may benefit from surgery. This is because weight loss surgery often improves Type 2 diabetes, even before patients start to lose weight. The rapid remission of Type 2 diabetes after gastric bypass surgery — independent of weight loss — is one of the most enticing discoveries about weight loss surgery. Why this occurs is a subject of current research. Dr Jacobus Frederick Jordaan 34 Pindara Magazine 2015\2016
Pindara Private Hospital Magazine - Issue Six
To see the actual publication please follow the link above