email to a friend
printer-friendly version| Can Weight Loss Surgery Treat My Diabetes? by Tomasz Rogula, MD, PhD - May 2007 What is severe obesity? Severe or ?morbid? obesity is defined as being approximately 100 pounds (45.5 kg) or 100 percent above ideal body weight. Between 3 and 5 percent of the United States adult population is severely obese. This condition is associated with the development of life-threatening complications such as diabetes, hypertension and coronary artery disease. Numerous therapeutic approaches to this problem have been advocated, including low-calorie diets, medication, behavioral modification and exercise therapy. However, the only treatment proven to be effective in the long-term management of morbid obesity is surgical intervention. Is diabetes related to my weight? Obesity is one of the most important factors for the development of Type 2 diabetes, a lifelong disease marked by high levels of sugar in the blood. It occurs when the body does not respond correctly to insulin, a hormone released by the pancreas. A mildly obese person has double the risk of developing diabetes, and a severely obese person has ten times the risk. The risk of diabetes increases with age, family history and obesity localized more in the abdomen (central obesity). Consuming fatty and high-carbohydrate foods leads to more fatty acids in the blood and a buildup of lipids in the liver and skeletal muscles, causing resistance to insulin and consequently diabetes. How is diabetes traditionally treated? The immediate goal in treating diabetes is to improve the symptoms through normalizing blood glucose levels. The ongoing goals are to prevent long-term complications like eye and kidney disease and damage to nerves and blood vessels. Strict control of blood glucose reduces the risk of death, stroke, heart failure and other complications. The glycosylated hemoglobin (HbA1c) test determines your risk for long-term complications. It measures how much glucose has been sticking to red blood cells and other cells. Reduction of HbA1c by even 1 percent can decrease the risk of complications by 25 percent. The primary treatments for Type 2 diabetes are diet and exercise. Appropriate meal planning includes choosing healthy foods and eating the right amount of food. Regular exercise is important for effective treatment of diabetes: it helps burn calories, manage weight, and improve control of blood glucose. When diet and exercise are not sufficient to maintain normal blood glucose levels, you may need to take medications that trigger the pancreas to make more insulin, help insulin work better, decrease the absorption of carbohydrates in the gut, or decrease glucose production in the liver. If you have poor blood glucose control despite lifestyle changes and medication, you will need to take insulin. Some people with Type 2 diabetes can stop medications after weight loss, but achieving and maintaining a healthy weight is sometimes very challenging. Multiple trials of different diets are frequently ineffective; surgically induced weight loss is proven to be the most effective in the long term. Can weight loss surgery improve my glucose levels? Immediately following bariatric surgery, blood sugar levels often improve to the point where medication can be reduced or eliminated, even before significant weight loss. Recent studies show that fat tissue changes following bariatric surgery, leading to improved insulin resistance. The most commonly performed bariatric surgery, Roux-en-Y gastric bypass, improves diabetes by causing rapid weight loss and excluding the initial portion of the jejunum from the flow of nutrients. Gastric bypass surgery ameliorates diabetes independently of weight loss, through mechanisms that remain unclear; it changes the production of various gut hormones, leading to an improvement in insulin secretion. Roux-en-Y gastric bypass is the most powerful operation to control diabetes. Almost 90 percent of obese patients who undergo Roux-en-Y gastric bypass are free from diabetes one year after surgery. These results typically persist for the rest of the patient?s life, as long as body weight is sustained. Resolution of diabetes is measured by normalized fasting blood sugar and glycosylated hemoglobin (HgA1C) concentrations. Following surgery, 80 percent of patients do not need to take diabetic medication and are able to stop their insulin. Patients who have had a milder form of diabetes (controlled with diet) for less than five years and who achieve greater weight loss after surgery are more likely to achieve complete resolution of diabetes. Almost 20 percent of severely obese patients develop diabetes; weight loss following gastric bypass in obese, nondiabetic patients decreases their likelihood of developing diabetes by 60 percent over four years. Bariatric operations, like many other surgeries, carry some risk, but the 0.5 percent major morbidity and mortality rate appears to be a reasonable risk for the tremendous clinical benefits as a diabetes treatment for obese patients. Should I consider weight loss surgery? If you are obese and have diabetes, weight loss surgery can be an excellent treatment for both. When selecting a center for surgery, choose one that offers a comprehensive pre-operative evaluation and is experienced in treating patients with diabetes.  Tomasz Rogula, MD, Ph.D. is a staff surgeon at the Cleveland Clinic Bariatric and Metabolic Institute. He has trained in weight loss surgery in the United States, Italy and France. In addition to bariatric surgery, his specialty interests include laparoscopic and robotic surgery, gastrointestinal surgery and hernia repair. Dr. Rogula has done multiple pioneering research studies on novel weight loss surgery procedures and published multiple articles and book chapters on bariatric and laparoscopic surgery.Want more information about surgery for diabetes? |
Most Active
Recent Topics