Bariatric/metabolic surgery and type 2 diabetes

Observations that type 2 diabetes can be improved or even resolved by surgical operations has been reported for almost a century.  Reports in the early 1920’s show that gastrointestinal operations for ulcers/cancer could cause dramatic improvement of diabetes.  After the evolution of bariatric surgery in the 1950’s observations of diabetes remission following gastrointestinal surgery were increasingly reported.

Since early 2000, experimental evidence that changes in the gastrointestinal anatomy can directly influence the level of glucose in the blood, has provided a mechanistic rationale for the use of surgery as an intentional treatment for diabetes.  Eleven random and controlled trials and large long term case studies had concluded that surgery in overweight/obese people with type 2 diabetes had short and long term improved results better than lifestyle changes and medication.

These studies had proved that the metabolic/bariatric surgery in patients with type 2 diabetes had greatly improved the glucose level in the blood, reduced the use of anti-diabetic medication and also dramatically improved the cardiovascular diseases including decrease in heart attacks, stroke, kidney function and improvement in overall mortality rates.

Naturally, greater weight loss had improved quality of life.

Studies had showed that metabolic/bariatric surgery had showed the substantial proportion of patients had experienced durable normalisation of blood sugar levels without the need for ongoing pharmacological treatment, and this is called disease remission.

All weight loss surgical procedure will help the control of type 2 diabetes through weight loss, but there are certain procedures with greater metabolic effect which has direct impact to improve the control of diabetes and the long term complications, and at the forefront of these procedures is the gastric bypass.

Within balance of complication, the longer the bypass segment of the gastrointestinal tract the better result on diabetes remission; especially if the patients have type 2 diabetes less than 5 years.

It is acceptable nowadays to offer metabolic/bariatric surgery for patients with type 2 diabetes with a BMI of 30 and above.

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