Weight Loss Surgery for Diabetes Management

Recent studies are confirming that weight loss surgery can provide dramatic improvements in treatment of people with Type 2 Diabetes.  One such recent study compared the results of many other studies of weight loss surgery and was published in the JAMA.  Type 2 diabetes, or adult onset diabetes,  is generally seen in over-weight adults. When an individual gains weight the body must produce more and more insulin to compensate for the additional fat. Once the pancreas has reached maximum porduction and cannot produce enough to keep the blood sugar normal, the result is called Type 2 diabetes.  By causing rapid weight loss via gastric by-pass or gastric banding surgery the body declines in size to a point where the pancreas is now again able to supply the proper amounts of insulin and the diabetes is “cured”.   If the person regains the weight the diabetes will return.  Some experts believe that gastric surgery also improves other hormones that effect blood sugar and that weight loss itself is not even necessary to see better blood sugar levels.

Weight loss surgery is not like cosmetic surgery. The risks are seen as relatively greater than cosmetic surgery and there are frequent complications involving the digestive system.  Costs of surgery are high and are generally not covered by insurance. For this reason many people travel outside of the US to obtain the surgery and wind up saving money.

Currently in the US the guideline for consideration for surgical treatment of diabetes is a BMI (search this term in metabolism.com) of greater than 40 or a BMI of 35 or more associated with some complication of diabetes such as leg ulceration.  Doctors are now struggling to decide if these guidelines should be relaxed so more people with diabetes would qualify for weight loss surgery.

Gary Pepper, M.D.

Editor-in-chief, metabolism.com

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