Can bariatric surgery significantly improve blood glucose control in Type 2 diabetes patients?

Type 2 diabetes is a chronic metabolic disorder marked by high blood sugar levels, often resulting from a combination of insulin resistance and inadequate insulin production. One emerging treatment option for patients struggling with blood glucose control is bariatric surgery, also known as metabolic or diabetes surgery. These procedures, traditionally aimed at weight loss, have shown significant potential in improving blood glucose control and even achieving long-term remission of diabetes.

The link between Type 2 diabetes and obesity

Obesity is a major risk factor for type 2 diabetes. Excess weight, particularly visceral fat, contributes to insulin resistance, a hallmark of type 2 diabetes. Many patients with type 2 diabetes find it difficult to manage their condition with lifestyle changes, medication, and insulin injections. This is where bariatric surgery steps in as a powerful alternative. By reducing the size of the stomach or altering the digestive tract, bariatric surgery can significantly affect the hormones involved in glucose regulation, leading to improved blood sugar control.

Types of bariatric surgery for diabetes

Several types of bariatric surgeries have been shown to improve blood glucose control, including gastric bypass and sleeve gastrectomy. These surgeries work by altering the digestive system to promote weight loss and, more importantly for diabetic patients, by affecting the secretion of hormones like GLP-1 (glucagon-like peptide-1), which plays a crucial role in regulating blood sugar.

1. Gastric bypass surgery: This procedure involves creating a small pouch at the top of the stomach and connecting it directly to the small intestine, bypassing most of the stomach and the first part of the small intestine. By limiting food intake and nutrient absorption, gastric bypass not only results in significant weight loss but also triggers early and increased secretion of GLP-1, promoting better blood sugar control.
2. Sleeve gastrectomy: In this procedure, a large portion of the stomach is removed, leaving a banana-shaped "sleeve." Like gastric bypass, it restricts food intake and influences the production of hormones that regulate glucose metabolism. Studies have shown that patients who undergo sleeve gastrectomy experience significant improvements in their blood sugar levels.

How bariatric surgery impacts blood glucose control

One of the most striking benefits of bariatric surgery for diabetic patients is the rapid improvement in blood glucose control post-surgery. Many patients can reduce or even eliminate their need for diabetes medications within days or weeks following surgery. This improvement is not solely due to weight loss; changes in gut hormone levels after surgery play a critical role. Hormones like GLP-1 and PYY (peptide YY) are secreted more efficiently, which enhances insulin sensitivity and stimulates insulin production, leading to better glucose regulation.

A key outcome of bariatric surgery is the possibility of long-term remission of diabetes. Studies have shown that over 80% of patients achieve glycemic resolution (normal blood sugar levels) and can discontinue diabetes medications within 12-18 months post-surgery. Even more promising, 36% of patients remain off diabetes medications ten years after the surgery, indicating that bariatric surgery can have lasting effects on blood glucose control.

Candidate selection for bariatric surgery

Not all patients with type 2 diabetes are candidates for bariatric surgery. According to guidelines, suitable candidates are typically adults over the age of 18 who have a body mass index (BMI) greater than 27.5 and have not been able to achieve adequate blood glucose control with lifestyle modifications and medications. Other factors that are taken into consideration include the patient's pancreatic function, the presence of comorbidities, and their suitability for anesthesia.

Each patient is evaluated individually by a team of healthcare professionals, including a bariatric surgeon, endocrinologist, and dietitian, to determine whether bariatric surgery is an appropriate treatment option.

Risks and considerations

As with any surgery, there are risks associated with bariatric surgery, including infection, blood clots, and complications related to anesthesia. In addition, some patients may experience nutritional deficiencies, such as vitamin B12, iron, and calcium, because of the reduced absorption of nutrients post-surgery. Long-term follow-up and adherence to a post-surgical diet and supplement regimen are essential for minimizing these risks.

It is also important to note that while bariatric surgery can lead to significant improvements in blood glucose control, it is not a cure for type 2 diabetes. Patients must continue to monitor their blood sugar levels, maintain a healthy diet, and engage in regular physical activity to sustain the benefits of the surgery.

Also Read: Here's how deep-fried, baked, grilled foods are driving diabetes in India

Conclusion

Bariatric surgery offers a powerful tool for improving blood glucose control in patients with type 2 diabetes, especially those struggling to manage their condition through conventional means. The surgery's ability to trigger changes in gut hormones, leading to better insulin sensitivity and glucose regulation, provides hope for long-term remission of the disease. However, it is important for patients to undergo a thorough evaluation and to be fully aware of the risks and lifestyle changes required post-surgery. With careful consideration and management, bariatric surgery can be a life-changing option for those with type 2 diabetes, providing not only improved blood sugar control but also a better quality of life.

Dr Ramen Goel is Consultant Bariatric & Metabolic Surgeon, Wockhardt Hospitals, Mumbai Central.

The views expressed here are the individual's and don't represent those of the paper.