The Emerging Role of Surgery in the Treatment of Diabetes
Diabetes is among the fastest growing health problems on the planet today. Within the next two decades, over 300 million people worldwide will have Type 2 diabetes. Numerous avenues of investigation have opened for researchers seeking to find a cure. In recent decades, weight loss surgery, or bariatric surgery, has proven highly successful in eradicating Type 2 diabetes among patients whose diabetes stems from being severely overweight.
It is now well demonstrated that approximately 90% of Type 2 diabetics experience resolution of their diabetes after Roux-en-Y gastric bypass surgery, the most commonly performed weight loss procedure in the U.S. A somewhat lower, but still remarkable 65% of patients undergoing LapBand surgery resolve their diabetes.
Both of these procedures are now widely performed in the United States with a minimally invasive, or laparoscopic procedure requiring a minimal hospital stay. Over 200,000 of these procedures are expected to be performed in the U.S. in 2007. Medicare and commercial health insurers increasingly recognize bariatric surgery as an effective treatment of diabetes that saves the plans money in the long run. Four major studies have demonstrated marked increased life expectancy after weiaght loss surgery. In most cases, there is no more need to fund the ongoing treatments of diabetes and its complications after weight loss surgery. So, it is clear that for obese individuals with Type 2 diabetes, there is a strong likelihood that their diabetes can be cured with surgery. But what about surgery for diabetic patients who are not severely overweight?
Recent studies have demonstrated that the surgical techniques applied in weight loss surgery may, in fact, result in resolution of diabetes in non-obese individuals also. A number of centers have begun reporting that even non-obese diabetic patients experience rapid resolution of diabetes after gastric bypass surgery. In many cases, patients are discharged from the hospital in a euglycemic state (normal blood sugar level) and never resume their diabetic medications! This very early and rapid resolution of glucose control is not explained simply by calorie intake or pounds lost. The phenomenon has lead many investigators to think that the surgical technique may fundamentally change the body’s regulation of blood sugar.
Most of the early and dramatic success resolving diabetes has occurred with gastric bypass surgery. A recent study, published in Surgery of Obesity Related Disease, vol 3, 2007, by Cohen et.al., described these researchers’ experience with a surgical procedure called duodenal-jejunal bypass, a fairly simple procedure that causes food intake to bypass the first part of the intestine. Their early findings are that these diabetic patients also resolved their Type 2 diabetes, independent of weight loss.
So, are we entering a new era in which Type 2 diabetes can be cured in a large percentage of cases with a minimally-invasive surgical procedure? Time will tell, but the early studies are leading many to believe that what has been called “bariatric” surgery, or “weight loss” surgery, may prove the most effective treatment yet in the battle against Type 2 diabetes. It may further the call to change thte name of the surgery to “Metabolic surgery”, as it serves to correct metabolic abnormalities and not just obesity.