Is weight loss surgery the answer for diabetes?

From ABC Health and Wellbeing, 21 January 2014:

Obesity surgery is hardly a new kid on the medical block. The first surgical attempts to help people lose weight were performed more than half a century ago.

Bariatric or metabolic surgery, which involves either chopping out or tying off a section of the stomach, is now one of the most rapidly growing forms of surgical intervention in Australia and around the world.

In the past this type of surgery was considered a last resort treatment for people with for serious, life-threatening obesity. However, evidence is emerging that surgery can slow or even stop the progression of type 2 diabetes, and doctors are now considering it as a new tool to treat type 2 diabetes in people who are struggling not only with their weight, but also their diabetes and other associated health issues.

“People used to think about the very high ends of Body Mass Index (BMI) requiring or being eligible for surgery, but now we see people with a BMI of 35 as being recommended to have surgery if their diabetes is not controlled, and a BMI over 35 is almost a third of our type 2 diabetics in Australia,” says Professor John Dixon, head of Clinical Obesity Research at the Baker IDI Heart and Diabetes Institute in Melbourne.

Studies such as the Swedish Obese Subjects study show that within two years of treatment, nearly three-quarters of obese people with type 2 diabetes who undergo surgery have their diabetes go into remission, which means their symptoms disappear completely and they no longer require medication.

In contrast, just 16 per cent of those who have more conventional treatments – that is medication and lifestyle changes, such as improved diet and increased physical activity – achieved remission.

Also the effects of surgery seem to last. Fifteen years after surgery, one-third of people were still free of diabetes symptoms, compared to just 7 per cent of those who did not have surgery.

Bariatric surgery works by reducing the amount of nutrients your gut can absorb, either by chopping out a section of the stomach (sleeve gastrectomy), tying off a section of the stomach (laparoscopic adjustable gastric banding), or by restructuring the stomach and rerouting the small intestine (Roux-en-Y gastric bypass).

The end result is less absorption, significant weight loss and other changes that, in many people, kick their diabetes back onto the ropes. They get their blood glucose levels under control using less medication than if they hadn’t had surgery.

“I think it’s emerging amongst the endocrinologists and diabetologists that it’s a really exciting way to go and that there are so many of their patients who are eligible for it,” says Dixon. Read more.

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