How Diabetes Affects Life Expectancy and If Bariatric Surgery Changes It
October 28, 2020Once a diagnosis of diabetes is made, many people worry about how it would affect their lives. Death is not something that we like to talk about, but it’s our nature to wonder how long we can live. There is no specific equation or answer because it can be influenced by many variables. It is believed that diabetes affects life expectancy.
Complications associated with diabetes, other existing conditions and when and how soon was diabetes diagnosed, all contribute to life expectancy.
How Diabetes Affects Life Expectancy
The CDC notes that diabetes is the seventh most common cause of death in the United States. Approximately 83.1 in every 100,000 people died of diabetes related causes in 2017.
On average, 1 in 3 Americans have prediabetes which equates to 88 million people and 34.2 million people are diagnosed with diabetes. Prediabetes is the time period before Type 2 diabetes develops, where the blood sugar is high, but no other symptoms are present. Unfortunately, 8 out of 10 people are not even aware that they have prediabetes.
Prediabetes is a turning point for people to make healthy lifestyles changes that can be significant in reversing diabetes in the early stages or prevent a person from developing it completely. Hence, it’s a silent disease that is indolent until the diagnosis of diabetes is made.
As a comparison of life expectancy with people in general, in 2018, the life expectancy for a man was 76.2 years and a woman 81.2 years. On average, diabetes shortens the life span by approximately 7 years. But this statistic does not account for the why. Life expectancy can change depending on when the initial diagnosis was made and depending on medical intervention.
For example, a person who lives an active lifestyle, maintains their glucose levels well and does not smoke will have a longer life expectancy than a person who smokes, has elevated glucose levels and does not exercise at all.
Diabetes is a chronic illness that requires constant medical care which require different strategies to control.
Some of the most common risk factors that decrease life expectancy in persons with diabetes are being overweight or obese, diet, smoking, low physical activity, and high levels of stress. Similarly, other health issues like heart disease, high cholesterol, and high blood pressure also contribute to decrease life expectancy. Furthermore, the longer a person has diabetes, the likelihood of life expectancy is reduced. In addition, the younger an individual is when they are diagnosed with diabetes, the more likely they will have complications that will lead to a shorten lifespan.
The Impact of Diabetes on Your Body
The impact of diabetes on the body is extensive. The American Heart Association (AHA) reports that diabetes causes a 2-4-fold increase in people who experience fatal heart disease and 16% strokes in adults 65 years or older. This is due to the high levels of sugar in the blood that damages nerves and small vessels, diminishing circulation.
The heart has to work harder to deliver the blood to those tissues which can stress the heart and cause it to fail. When oxygen and nutrition cannot be delivered by blood, then those tissues die, which is called necrosis.
How to Increase Your Life Expectancy if You Have Diabetes
So, what can a person with diabetes do to increase their life expectancy?
The key is to maintain optimal blood glucose control. Keeping blood sugar levels at the normal range can mitigate complications of diabetes and hence increase life expectancy. Enjoying a healthy lifestyle with regular activity, a well-balanced diet and losing weight will lower your stress level and promote good blood circulation.
As obesity is one of the several risk factors linked to Type 2 diabetes, it is one of the variables that people change, to improve their lifestyles. Unfortunately, studies show that weight loss with a diet and exercise regiment only gives marginal results especially in regards to diabetes versus with bariatric surgery. Remission of diabetes for bariatric surgery was 60% versus 5.9% in the medical intervention group in one study. 1
The Benefits of Bariatric Surgery With Diabetes
Bariatric surgery can provide more than weight loss. Especially for someone who is severely obese and have diabetes, it can decrease the risk of heart attack and strokes. 2 Patients with diabetes who have improved blood glucose levels, can have a reduction of risk for diabetic neuropathy in their hands or feet as well.
The most common types of bariatric surgery include gastric bypass, gastric sleeve as well as gastric banding. They all have varying different diabetic remission rates. A recent 5-year randomized study in 2018 showed comparable diabetic remission rates in both the gastric bypass and sleeve gastrectomy with a slightly better profile in gastric bypass.3
Most significantly, due to weight loss and improved overall markers including glucose levels, half of diabetic patients experienced diabetic remission for an average of seven years.2 The 24% that recur, the diabetes is less severe, usually requiring dietary changes and less medications to treat.
Bariatric surgery is also known as a metabolic surgery because it reduces the chance of developing diabetes, heart disease and stroke. Bariatric surgery reverses insulin resistance, lowers blood pressure, lowers cholesterol and changes hormones in your gut. The positive effects of bariatric surgery are not only limited to a mechanical effect.
The impact of bariatric surgery is multifactorial. As per the American Society for Metabolic & Bariatric Surgery (ASMBS), it has helped or improved more than 40 obesity-related diseases, including diabetes, heart disease, cancers, and high blood pressure. Bariatric surgery has seen significant improvements in overall safety. The mortality rate is 0.1% - less than in gallbladder surgery (0.7%).4 It has also improved life expectancy by 89%. 5
The positive effects of bariatric surgery have been recognized and has been accepted and recommended by the American Heart Association, American College of Endocrinology and the American Diabetic Association as an effective treatment for patients with Type 2 diabetes.
Nevertheless, undergoing surgery for weight loss and treatment of diabetes should not be rushed. Bariatric surgery is an effective and initially a forceful tool, however it should not be used as a crutch. Diet and lifestyle modification along with exercise and follow-up is an integral part of a successful journey. There is also an intensive pre-operative workup by an interdisciplinary team that is required. People with diabetes should have an informed discussion with their healthcare providers about the potential benefits, along with the risks of weight loss surgery.
References
- Cummings DE, Arterburn DE, Westbrook EO, et al. Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial. Diabetologia. 2016;59(5):945‐953. doi:10.1007/s00125-016-3903-x
- Association Between Bariatric Surgery and Macrovascular Disease Outcomes in Patients With Type 2 Diabetes and Severe Obesity. David P. Fisher, MD1; et al. JAMA. 2018;320(15):1570-1582. doi:10.1001/jama.2018.14619
- Salminen P, Helmiö M, Ovaska J, et al. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years Among Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial. JAMA. 2018;319(3):241‐254. doi:10.1001/jama.2017.20313
- Agency for Healthcare Research and Quality (AHRQ). (2007). Statistical Brief #23. Bariatric Surgery Utilization and Outcomes in 1998 and 2004. Accessed October 2013 from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb23.jsp
- Adams, T. D., et al. (2007). Long-term mortality after gastric bypass surgery. New England Journal of Medicine. 357 pp. 753-761 Accessed October 2013 from http://www.nejm.org/doi/full/10.1056/NEJMoa066603
 | ABOUT THE AUTHOR Dr. Jun Levine is a bariatric and minimally invasive surgeon with Winthrop Surgical Associates. She attended medical school at SUNY Downstate Medical School and practiced in New York City before moving to NYU Winthrop. Beyond bariatric surgical procedures such as gastric bypass and gastric sleeve, Dr. Levine also specializes in minimally invasive hernia repair, minimally invasive gallbladder removal and surgical treatment for gastroesophageal reflux disease (GERD). |
