Metabolic Surgery a treatment option for patients with type 2 diabetes
Lisa Ranes RD CDE
Clinical Coordinator
– Diabetes, Endocrinology and Metabolism
Billings Clinic
The other day I was teaching our two month post metabolic
surgery nutrition class and one of the patients in the class has decreased her
insulin by at least 150 units. She has
had type 2 diabetes for 20 years and was on large doses of basal and bolus
insulin. She is off her blood pressure
and lipid lowering medications and she feels GREAT. Another one of our patient’s diabetes had
gone into remission. Her A1C is normal
and is no longer taking diabetes medication.
This to me is unbelievable, who would have thought that a surgical procedure could drastically improve diabetes and even put it into remission.
Over 10 years ago the resolution of type 2 diabetes was
observed as an additional outcome of surgical treatment of morbid obesity. Approximately 90% of the patients with type 2
diabetes who have metabolic/bariatric
surgery see improvement in their diabetes by lowering of blood glucose,
reducing the dosage and type of medication required and improving
diabetes-related health problems.
Remission of type 2 diabetes is seen in 78% of the individuals who have
surgery.
The bypass procedures, Roux-en-y and biliopancreatic
diversion are more effective treatments for diabetes than other
procedures. Resolution or improvement in
blood glucose happens within days after these surgeries, long before any significant
weight loss has occurred.
The precise mechanism of how the metabolic/bariatric
surgeries resolve or improve type 2 diabetes is not totally clear yet. The fact that the improvement of blood
glucose is not dependent on weight loss indicates other possible mechanisms
must be involved. Such mechanisms as
decreased food intake, partial malabsorption of nutrients and alteration in the
gastrointestinal tract (GI), could explain the improvement. The alteration of the GI tract stimulates
changes in the incretin system in turn affecting glucose balance.
Surgery is considered an accepted treatment option for type
2 diabetes in individuals with a BMI equal to or greater than 35. It can be
performed safely and has a low complication rate compared to other common
operative procedures.
Surgery is a treatment option that should be discussed with
your type 2 diabetes patients who are struggling with their weight and glucose
control. Patients deserve to know of the
benefits that surgery can offer them.
We need to recognize that our patients have self management skills that
can help them be successful with surgery and surgery is not the “easy way out”
but a life long commitment to healthy lifestyle change.