Bariatric Surgery and Diabetes

Weight-loss surgery cures diabetes?

Yes, it's true.  Not only does bariatric surgery cure type II diabetes; it is the only cure.  Before we talk about that, a word should be said about diabetes in general: 

Type 2 diabetes is often lumped with other metabolic diseases that overweight adults tend to have, like high blood pressure and high cholesterol, but in truth, diabetes is quite a bit worse. 

If you are someone who has had diabetes for a while, then you understand the difference:  Unlike those other metabolic diseases, diabetes always progresses.  It’s relentlessly progressive.  You can slow the damage suffered by your organs – the feet, eyes, heart, kidneys, and brain – but you cannot completely stop it.

It’s different with high blood pressure and high cholesterol.  With those diseases, as long as you take the right medication, you have a very good chance of avoiding organ damage altogether.  Not true with diabetes.  Even if you are downright saintly with your medications and blood sugar checks, the disease will worsen with time.  Your diet-controlled diabetes will one day require oral medication.  That one pill will eventually turn into two, and later it will become three.  With time, your sugar will become impossible to control without insulin;and further on it will be hard even with insulin – the “end-stage” diabetic.  With proper, meticulous care, this progression could be slowed, perhaps even by decades, but it can never really be turned off – that is until it was learned that bariatric surgery had a curative effect on Type 2 diabetes.

The finding that bariatric surgery and diabetes are related was first publicized in the nineties by an insightful gastric-bypass surgeon, Dr. Walter Pories, whose cartoon is shown (with permission).

Early in his career, Dr. Pories performed bariatric surgery because his patients needed the weight loss.  Predictably, many of these obese patients were diabetics.  Treating these folks, he gradually noticed something that he did not expect:  Their diabetes was disappearing.  Frequently the diabetes – often severe – disappeared right after the operation, even before the patient went home.  He published his findings in Annals of Surgery in 1995 in a paper titled, “Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus.”1

Unfortunately, the first part of his paper’s title proved accurate:  nobody did think it, and not many seemed interested in trying.  Though the facts that bariatric surgery and diabetes are clearly related was laid before them with solid, scientific evidence, the medical community seemed determined to ignore it.   Surgery for diabetes apparently was somehow too radical, too unexpected.  Dr. Pories has spent considerable energy since that time trying to spread awareness of that simple, important fact: Weight-loss surgery cures diabetes!

Fortunately, his persistence (and that of many others) finally seems to be paying off:  The medical community at large is moving toward acknowledgement of surgery’s place in the management of type 2 diabetes.  Among the important recent milestones:

  1. Bariatric surgery is now included in the American Diabetic Association’s (ADA) Standards of Medical Care in Diabetes.2
  2. In 2011, The International Diabetes Federation announced a new position supporting bariatric surgery to treat type 2 diabetes in obese patients.3
  3. The New England Journal of Medicine published two randomized clinical trials in April which compared bariatric surgery to standard, nonsurgical treatment in severe diabetics.  These trials showed that diabetes was eliminated in the majority of the surgery patients, whereas similar cures were achieved in zero patients who got robust medical care.4,5

So, these are important milestones, and they represent progress in awareness.  Unfortunately, bariatric surgery’s success with diabetes still remains one of the best kept secrets in medicine. 

If you are interested in learning more about how bariatric surgery and diabetes work together to eliminate your own diabetes, schedule a consult or a seminar today!

Citations:

1.  Pories WJ, Swanson MS, MacDonald KG, et al.  “Who would have thought it? An operation proves to be the most    effective therapy for adult-onset diabetes mellitus.”  Ann Surg. 1995 Sep;222(3):339-50; discussion 350-2.

2.  American Diabetes Association.  “Standards of medical care in diabetes--2011.”  Diabetes Care. 2011 Jan;34 Suppl 1:S11-61.

3.  Dixon JB, Zimmet P, Alberti KG, et al.  “Bariatric surgery: an IDF statement for obese Type 2 diabetes.”  Diabet Med. 2011 Jun;28(6):628-42.

4.  Schauer PR, Kashyap SR, Wolski K, et al.  “Bariatric surgery versus intensive medical therapy in obese patients with diabetes.” N Engl J Med. 2012 Apr 26;366(17):1567-76.   

5.  Mingrone G, Panunzi S, De Gaetano A, et al.  “Bariatric surgery versus conventional medical therapy for type 2 diabetes.”  N Engl J Med. 2012 Apr 26;366(17):1577-85.