Bariatric Surgery – The Next Treatment for Diabetes?

In recent years, more physicians are starting to embrace surgery as a therapy for type 2 diabetes. Yes, surgery. You may have heard of “bariatric surgery,” which has primarily been reserved for overweight individuals (defined as a body mass index >35 kg/m² – calculate yours at www.nhlbisupport.com/bmi/bmicalc.htm) and viewed as a “last resort” procedure to promote weight loss. However, researchers have discovered that these surgeries, which reorganize how food passes through the digestive tract, can have an amazing impact on diabetes. For a majority of individuals with type 2 diabetes who undergo bariatric surgery, diabetes medications such as insulin and oral agents become no longer necessary. There are different types of bariatric surgeries, but the two most common are the “Roux-en-Y gastric bypass” (RYGB) and “Adjustable Gastric Banding.” Both procedures greatly reduce the amount of food one eats, inducing on average about 140 lbs weight loss with RYGB and about 80 lbs with gastric banding. Gastric banding actually squeezes the stomach, whereas the RYGB bypasses a good portion of the stomach and also bypasses some of the gut - decreasing the amount of calories absorbed. Clinical data indicate that the RYGB procedure is more effective for treating diabetes (more than 7 out of every 10 patients discontinue diabetic medications, often within days) and in the right hands may even be slightly safer than the gastric banding technique, in which only about half the patients are able to discontinue medications; however, gastric banding is also gaining in popularity due to the ease and potential reversibility of the procedure.

These surgeries – increasingly called "metabolic surgeries" when performed to treat diabetes rather than induce weight loss – require specialized surgeons and may not be performed in particular hospitals. But the number of providers is growing very quickly. Medical costs currently range from $20,000 to $25,000; however, insurance may be provided depending on the insurance provider and the state. Medicare recently expanded coverage, especially for those attempting to correct another illness, such as diabetes. Like any surgery, bariatric surgery carries risks and may cause additional complications, such as infection, ulcers, and the need for reoperation – mortality rates are typically less than 1%. But if you are interested, you can speak with your primary care physician and start educating yourself on the procedure’s risks and benefits. In the mean time, researchers are working hard to understand the specific mechanisms in hopes of developing a drug that can deliver the same benefit.