Health Matters 6/25: Weight-Loss Surgery Can Help Treat Diabetes

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By Wai-Yip Chau, MD

Did you know that, according to the Centers for Disease Control and Prevention (CDC), nine out of 10 people with newly diagnosed type 2 diabetes are overweight or obese?

In fact, obesity is one of the main risk factors for type 2 diabetes, which affects more than 34 million adults in the United States today.

Fortunately, however, treating obesity can also help treat diabetes and reduce the risk for its debilitating complications.

While diet and exercise are important components of weight loss, in many cases bariatric surgery is the most effective treatment for obesity and its related health conditions, such as diabetes.

The Center for Bariatric Surgery & Metabolic Medicine at Penn Medicine Princeton Medical Center (PMC) offers several safe and effective bariatric surgery options, performed by skilled, board certified surgeons. Nearly all of the operations are performed laparoscopically, using minimally invasive techniques.

A Chronic Condition

Type 2 diabetes is a chronic condition characterized by a problem with how insulin, a hormone that is produced by the pancreas, regulates blood sugar in your body.

In the early stages of diabetes, your body overproduces insulin to control blood sugar levels. But as the disease progresses, your body loses the ability to produce insulin at all, causing blood sugar to remain high.

And high blood sugar can wreak havoc on your body.

Consider that diabetes is the number one cause of kidney failure, lower limb amputations, and adult blindness in the United States, according to the CDC, and it is the seventh-leading cause of death.

Obesity Leading Risk Factor

While there are many risk factors for type 2 diabetes, including age, family history and ethnicity, having obesity is by far one of the most common.

Studies show that excess weight can cause your cells to become less sensitive to insulin. At the same time, research has indicated that people with obesity have unusual levels of certain proteins that play a key role in regulating insulin and blood sugar.

In addition, while obesity in general increases the risk for diabetes, scientists have found that where the excess weight is stored also influences the risk for the disease.

Specifically, people who store excess weight in their waistline and abdomen are at greater risk than those who store it in their buttocks and thighs.

Effective Treatment for Type 2 Diabetes

According to the American Society for Metabolic and Bariatric Surgery (ASMBS), nearly all individuals who have bariatric surgery show improvement in their diabetic state.

Studies of bariatric surgeries performed on more than 135,000 people found that nearly 90 percent of patients enjoyed these benefits:

• Lower blood sugar.
• Reduced dosage and types of medication required.
• Improvement in diabetes-related health problems.

In 78 percent of individuals, type 2 diabetes went into remission. Blood sugar was reduced to normal levels, eliminating the need for diabetes medications.

Two of the most common bariatric surgeries performed in the United States are gastric bypass surgery and sleeve gastrectomy.

Gastric bypass surgery alters the gastrointestinal tract to cause food to bypass most of the stomach and the upper portion of the small intestine. According to the ASMBS, the procedure results in significant weight loss and causes remission of type 2 diabetes in 80 percent of patients, as well as improvement of the disease in an additional 15 percent of patients.

Sleeve gastrectomy is an operation that removes a large portion of the stomach. The remaining stomach is narrow, like a sleeve, and provides a much smaller reservoir for food. Diabetes remission rates after sleeve gastrectomy are more than 60 percent, according to the ASMBS, and in some studies, similar to the results seen after gastric bypass.

Not only do these procedures limit the amount of food that can be consumed, but ongoing research also shows that the procedures seem to cause changes in gut hormones that help improve obesity and diabetes.

To qualify for bariatric surgery, an individual must have a BMI of above 40 or a BMI of 35-39.9 and a disease, such as diabetes, that has been linked to obesity.

A Minimally Invasive Approach

The Center for Bariatric Surgery & Metabolic Medicine at PMC offers patients several options for minimally invasive weight-loss surgery, including robot-assisted sleeve gastrectomy.

Robotic technology puts a surgeon’s hands at the controls of a state-of-the-art surgical platform, enabling them to perform even the most complex and delicate procedures with precision through very small incisions.

The potential benefits of robot-assisted sleeve gastrectomy include a lower risk of complications and, in some cases, a shorter recovery time.

When bariatric surgery is considered medically necessary, insurance companies will often cover it.

If you have obesity-related diabetes, talk with your doctor about bariatric surgery. In addition to losing excess weight, bariatric surgery can help you lower your blood sugar levels and regain your health.

For more information about the Center for Bariatric Surgery & Metabolic Medicine at PMC or to find a bariatric surgeon affiliated with Penn Medicine Princeton Health, call 609-785-5870 or visit www.princetonhcs.org.

Wai-Yip Chau, MD, is board certified in general surgery and specializes in bariatric and metabolic surgery. He is a member of the Medical Staff at Penn Medicine Princeton Health.