Bariatric surgery in the management of diabetes mellitus

Did you know that the results of controlled clinical trials have shown that surgical treatment of obese patients with Bariatric surgery in the management of diabetes mellitus (DM2) allows better control of glycemia and cardiovascular risk factors, less use of medications and higher remission rates compared to different treatment alternatives doctor (Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA et al. Bariatric Surgery versus Intensive Medical Therapy for Diabetes – 5-Year Outcomes. N Engl J Med 2017; 376: 641-51.)

The presence of diabetes mellitus is a compelling argument to perform bariatric surgery in those who are eligible according to international criteria. Glycemic control improves in the months after laparoscopic adjustable gastric banding, but it improves more rapidly and completely after laparoscopic Roux-en-Y gastric bypass surgery. Thus, both types of surgery are capable of improving or even curing DM2, but the mechanisms may differ. ¹

Bariatric surgery, which includes procedures like gastric bypass, sleeve gastrectomy, and gastric banding, has been shown to significantly benefit diabetic patients in several ways:

1. Weight Loss: Bariatric surgery results in significant and sustained weight loss, which is often difficult to achieve through other means like diet and exercise alone. Excess weight is a major risk factor for developing type 2 diabetes, and losing weight can help improve insulin sensitivity and glycemic control.
2. Improved Insulin Sensitivity: Bariatric surgery can lead to improved insulin sensitivity even before significant weight loss occurs. This means that the body’s cells become more responsive to insulin, allowing for better regulation of blood sugar levels.
3. Resolution of Diabetes: Many diabetic patients experience remission or significant improvement in their diabetes following bariatric surgery. Some studies have shown that a significant portion of patients no longer require diabetes medications post-surgery, or their medication doses can be significantly reduced.
4. Changes in Gut Hormones: Bariatric surgery alters the anatomy of the digestive system, leading to changes in the production of gut hormones such as ghrelin, glucagon-like peptide-1 (GLP-1), and peptide YY (PYY). These hormonal changes can contribute to improved insulin secretion, reduced appetite, and better glucose metabolism.
5. Reduction of Inflammatory Markers: Obesity is associated with chronic low-grade inflammation, which plays a role in insulin resistance and the development of type 2 diabetes. Bariatric surgery has been shown to reduce levels of inflammatory markers in the body, potentially improving insulin sensitivity and diabetes control.
6. Improved Cardiovascular Health: Diabetes is a major risk factor for cardiovascular disease. Bariatric surgery not only helps in controlling diabetes but also reduces other cardiovascular risk factors such as high blood pressure, dyslipidemia (abnormal levels of cholesterol and/or fats in the blood), and obstructive sleep apnea, leading to overall improvements in heart health.
7. Long-Term Benefits: Studies have demonstrated the long-term effectiveness of bariatric surgery in maintaining weight loss and diabetes remission. This suggests that the metabolic benefits of surgery can be sustained over time, leading to prolonged improvements in diabetes management and overall health.
8. Quality of Life: Beyond the physiological benefits, bariatric surgery often leads to improvements in quality of life for diabetic patients. This may include increased mobility, reduced reliance on medications, improved self-esteem, and a decreased risk of diabetes-related complications such as nerve damage, kidney disease, and vision problems.

Overall, bariatric surgery offers a multifaceted approach to managing diabetes in obese individuals, addressing both weight loss and metabolic factors, and often resulting in significant improvements in diabetes control and overall health. However, it’s important for patients to understand that bariatric surgery is not a guaranteed cure for diabetes and requires lifelong commitment to lifestyle changes and medical follow-up.