Some researchers believe it is due to GLP-1, a hormone made in the lower small intestine that helps with blood glucose control and weight loss. The diabetes medication exenatide (Byetta) works by behaving like GLP-1. Studies have shown that blood GLP-1 levels increase after weight loss surgery. Solving the mystery of how weight loss surgery puts Type 2 diabetes into remission could provide the basis for powerful new diabetes medications. In the absence of such a breakthrough, the question at the heart of the debate is: who stands to benefit the most from surgery, and who should stick with a more traditional treatment of diet, exercise, and medication? Weight loss surgery has to work in tandem with lifestyle changes. It reduces portion size, causes some malabsorption of calories and alters some of the hormones. However, it is not a ‘magic bullet’. The 60-80% of excess weight loss that occurs over a 12-18 month period allows someone who has been struggling with obesity the time to modify their diet and exercise to achieve a healthy lifestyle. What are the downsides? Weight loss surgery has a much higher upfront cost compared to medication and lifestyle modification. However, those costs can be recouped in as little as four years in patients with Type 2 diabetes. Long-term follow-up is necessary. Patients are advised to take regular vitamin and mineral supplements to prevent micronutrient deficiencies and bone disease. To avoid this, Dr Jordaan typically reviews patients at least yearly. As with any surgery, there is the risk of a surgical complication: bleeding, infection, leak, cardiac event, blood clot or damage to other organs. However for comparison, the overall level of risk for a gastric sleeve (the most commonly performed weight loss procedure) is similar to having a gallbladder removed and less than having a joint replacement. This has to be weighed against the risk of medical complications from the continued combination of obesity and Type 2 diabetes. What’s the bottom line? Weight loss surgery offers an opportunity for those with Type 2 diabetes to put their disease into remission. That is, living their day-to-day life with no medication, no insulin. With wellcontrolled blood sugars patients reduce the damage being done to their eyes, kidneys, heart, blood vessels, teeth and nerves. Dr Jordaan states that patients now have an opportunity to decide if they want a lifetime of medical management or a surgical procedure. “I think people are entitled to be given a choice, to be educated about the possibilities that exist today,” he says. Dr Jacobus (Jorrie) Jordaan MB ChB MMed Surg (Pret) (Hons) FCS (SA) FRACS is a Specialist Upper Gastrointestinal and Endocrine surgeon with 25 years experience. Having performed thousands of advanced and complicated surgical operations, he is among Australia’s most experienced specialists in minimally invasive weight loss (bariatric) surgery. Dr Jordaan and his team of dietitians, psychologists, nurses, anesthetists and medical specialists combine their years’ worth of expertise, innovation and people skills to ensure excellent patient experiences and long-term results. pindaramagazine.com.au Pindara Magazine 35
Pindara Private Hospital Magazine - Issue Six
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