Type 2 Diabetes

Can weight loss surgery help with type 2 diabetes?

Type 2 diabetes can have several health-related complications.

Reducing your weight can also reduce your risk of complications of type 2 diabetes.

Weight loss surgery is an option that many patients are now considering to help with their type 2 diabetes.

The rate of bariatric surgery programs increased from 158,000 in 2011 to 196,000 in 2015.

Let’s review why weight loss surgery may or may not be a good option for people with type 2 diabetes.

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The connection between obesity and type 2 diabetes

The prevalence of obesity is on the rise. So too is the prevalence of type 2 diabetes. This is no coincidence. Obesity is the number one risk factor for type 2 diabetes. The term “diabesity” was created to highlight this close relationship between the two conditions.

The majority of individuals with type 2 diabetes are overweight or obese.

Obesity increases the risk of developing insulin resistance. This is because, in people who are obese, fat tissue releases higher amounts of substances involved in the development of insulin resistance.

These substances include the following:

  • Non-esterified fatty acids

  • Glycerol

  • Hormones

  • Pro-inflammatory cytokines

  • And other factors

The islet beta cells in your pancreas release insulin. When you have insulin resistance and dysfunction of these pancreatic islet beta cells, it is difficult to control blood glucose levels.

Not only does obesity increase the risk of developing type 2 diabetes, but it also compounds the health risks related to diabetes. It also complicates the management of type 2 diabetes.

When would surgery be recommended?

Doctors usually recommend weight loss surgery when lifestyle changes are not effective enough. Severe morbid obesity is a disease that can lead to multiple adverse health effects. These adverse health effects can be reversed or improved by a successful weight loss program. If nonsurgical methods aren’t cutting it, then surgery may be a good option.

Weight loss surgery is often recommended in patients with obesity and a high risk of cardiovascular events such as heart attack and stroke. Patients with non-alcoholic steatohepatitis (the medical term for fatty liver disease) may be good candidates for weight loss surgery too. Patients with gastroparesis may also consider weight loss surgery.

Types of weight loss surgery

Gastric sleeve

In gastric sleeve surgery, the weight loss surgeon removes a large part of your stomach. This helps you to feel full more quickly since there is less room for food. This surgery also lowers ghrelin, the hormone that makes you feel hunger. Gastric sleeve surgery also activates GLP-1 hormone, which can help with weight loss.

Laparoscopic vertical sleeve gastrectomy is now the most commonly performed bariatric service in the world.

As far as weight loss surgeries go, a gastric sleeve is less invasive. More than 60 percent of people who get gastric sleeve surgery show no signs of diabetes afterward. And people usually lose 50 percent of their extra weight.

There are some downsides to the surgery, though. You cannot reverse the surgery once completed. Also, since you have less room in your stomach, you can’t absorb as many vitamins and minerals as before the surgery. This could lead to nutrient deficiencies and other health problems.

Gastric bypass

In gastric bypass surgery, the bariatric surgeon creates a small stomach pouch. They do this by dividing the top of the stomach from the rest. When you eat, food will go into this small pouch. This means it bypasses the top part of the small intestine. This is what we call a biliopancreatic diversion surgery. You feel full faster and absorb fewer calories and nutrients.

There are two main types of gastric bypass surgery. The first is roux en Y gastric bypass surgery, and another type is one anastomosis. It is also called single anastomosis gastric bypass surgery or mini gastric bypass surgery. This type of gastric bypass usually involves less surgery time and avoids some post-operative complications that can come along with roux en Y gastric bypass surgery.

After gastric bypass surgery, up to 80 percent of people show no signs of diabetes. People usually lose 60 to 80 percent of their excess weight! This is a highly effective surgery for patients with severe obesity. The weight loss achieved with gastric bypass surgery is comparable to gastric sleeve in the short term. However, in the long term, gastric bypass appears to result in better weight loss. Gastric bypass surgery can also help with conditions related to obesity.

One study found that the mean body mass index (called BMI for short) decreased from 46 to 26.6 after gastric bypass surgery. Notably, the quality of life index was satisfactory in all parameters from six months onwards after the surgery.

One major downside to gastric bypass surgery is that your body can’t absorb as many nutrients. This could lead to several health problems, such as a condition called dumping syndrome. Gastric bypass surgery is not reversible.

Adjustable gastric band

With adjustable gastric banding surgery, the surgeon places an inflatable band around the top part of the stomach. This is what we call a gastric balloon. This forms a small pouch where the food goes. Since this pouch is so small, it fills up quickly. This means you will feel full faster.

The adjustable gastric band was a highly popular bariatric surgical procedure in the United States since the early 2000s. In the 20 years since then, it has lost its popularity. This is because of the high rate of redo surgeries that are required. It’s also because of complications such as band erosion.

Adjustable gastric band surgery now represents less than 5.5 percent of all bariatric surgeries.

This surgery is the least invasive bariatric surgery. Your surgeon won’t cut the stomach or move the intestines around like in some other weight loss surgeries. This is why adjustable gastric band surgery tends to have fewer complications. It’s also reversible, so you can always have the band adjusted or taken out later if you decide to do so.

Between 45 and 60 percent of people who have this surgery end up being free of diabetes afterward.

As with any surgery, there is potential for adverse effects. There can be problems with the adjustable band. It can slip out of place or become worn out. If this happens, you may require another surgery to fix it. You’ll also lose less weight with this surgery than some of the other weight loss surgery options.

Electric implant device

When a patient gets an electric implant device, the surgeon places an electrical device just underneath the skin of your abdomen. This device helps in the control of signals in the vagus nerve. The vagus nerve provides a direct connection from the stomach to the brain. This electric implant device can help to reduce the feeling of hunger.

This is a relatively minor surgery, and it is reversible. Once the patient has achieved surgical weight loss, they can have the electric implant device removed.

Adverse effects to look out for after electric implant include the following:

  • Heartburn

  • Pain

  • Difficulty swallowing

  • Belching

  • Nausea

  • Chest pain

Risks of surgery

All surgeries come with risks. The less invasive surgeries have lower long-term risk afterward. However, these less invasive surgeries also tend to have considerably less weight loss.

Robotic surgery tends to have fewer complications because the incisions are smaller.

Between five and eight percent of bariatric weight loss procedures will fail and require surgical correction. Each type of weight loss surgery has specific complications that might require surgery to correct.

Gastric sleeve surgery risks

One study looked at 43 patients after laparoscopic sleeve gastrectomy. 60 percent of patients had sleeve stenosis. Four percent of patients had food stuck above the stenosis. 70 percent of patients had obstructive symptoms and sleeve stenosis.

Gastric sleeve surgery also increases your risk of GERD (gastroesophageal reflux disease). It’s also possible that there is a twisting of the stomach pouch after surgery.

Complications of gastric sleeve surgery include the following:

  • GERD

  • Sleeve stenosis

  • Gastrocutaneous fistula

  • Gastropleural fistula

  • Stomach torsion

Gastric bypass surgery risks

As we discussed above, gastric bypass surgery can reduce your body’s ability to absorb nutrients. This can also affect the absorption of pharmaceutical drugs. Since food and drugs will bypass the stomach’s acidic environment, bile salts won’t help. There is also less surface to absorb the drugs, so there might be a reduced efficacy of medications you are taking.

Gastric bypass surgery is also controversial because of its role in biliary reflux. This can lead to changes in the esophagus cells, which can increase the risk of esophageal or stomach cancer.

Other risks of gastric bypass surgery include the following:

  • Infection at the surgical site

  • Need for reoperation

  • Anastomotic stricture

  • Pulmonary embolism (a blood clot in the lung)

Gastric band surgery risks

Over the years, the long-term complications of gastric bands have led to many of them being removed. There can be an erosion of the band, and it can also move. Once it moves into the stomach, it can even move into the small intestine. This can lead to biliary obstruction.

Gastric band surgery is associated with a longer length of stay, higher post-surgical ICU admissions, and a higher overall risk of disease.

Additional risks of gastric band surgery include the following:

  • Infection

  • Anastomotic leakage

  • Anastomotic stomach perforation

  • Adhesions around the anastomosis

  • Internal hernia around the tubing

  • Adhesions to the tubing

  • Tubing failure

Life after surgery

Reducing your weight also reduces your risk of other health conditions. It can increase the quality of life and reduce your risk of all-cause mortality.

Surgery is an effective way of getting sustainable and significant weight loss in people with obesity. It can help patients to achieve glycemic control. It can reduce the risk of heart disease. You can also improve your hormone health by reducing incretin and insulin sensitivity.

Do keep in mind that not everyone gets the results they want from weight loss surgery. Many patients will experience weight loss that is less than 20 percent of their initial weight.

Patients can reach weight plateaus, or they can gain back the weight post-surgery. This is what we call weight recidivism, which is more than 10 percent weight regain from the lowest post-surgical weight.

Up to 20 percent of all gastric bypass bariatric surgery procedures’ patients and 40 percent of morbidly obese patients experience significant weight recidivism post-surgery.

After surgery, you may need to take medication as an adjunct treatment to help to reach your weight loss goals. Remember that surgery doesn’t take away unhealthy habits. Healthy nutrition and physical activity programs can improve your surgical results.

Conclusion

If you have type 2 diabetes and are looking for some help on your weight loss journey, the best place to start is nutrition and exercise.

If these lifestyle changes don’t help you to achieve the diabetes weight loss you are looking for, then a weight loss surgery program might be a surgical option to consider.

However, it is vital to note that all surgeries come with risks and can lead to complications in the short and long term.

In many cases, your body can’t absorb as many nutrients after weight loss surgery which could lead to several health problems.

As always, it’s essential to discuss this decision with your health care provider first.

Sources

  1. Alawad, M; Abukhater, M & Al-Mohaimeed, K. (2020). Eroded adjustable gastric band migration causing gastric obstruction and perforation in a pregnant lady. Int J Surg Case Rep. 71 (1), 192-5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533630/
  2. Andreasson, K & Videhult, P. (2017). Gastric bypass versus sleeve, pros and cons. Lakartidningen. 27 (114), ER3H. Available from: https://pubmed.ncbi.nlm.nih.gov/28972649/
  3. Braghetto, I & Csendes, A. (2017). Single anastomosis gastric bypass (one anastomosis gastric bypass or mini gastric bypass): The experience with billroth II must be considered and is a challenge for the next years. Arq Bras Cir Dig. 30 (4), 267-71. Available from: https://pubmed.ncbi.nlm.nih.gov/29340552/
  4. Brocks, DR; Ben-Eltriki, M; Gabr, RQ & Padwal, RS. (2012). The effects of gastric bypass surgery on drug absorption and pharmacokinetics. Expert Opin Drug Metab Toxicol. 8 (12), 1505-19. Available from: https://pubmed.ncbi.nlm.nih.gov/22998066/
  5. Carbajo, MA; Luque-de-Leon, E; Jimenez, JM; Ortiz-de-Solorzano, J; Perez-Miranda, M & Castro-Alija, MJ. (2017). Laparoscopic one-anastomosis gastric bypass: Technique, results, and long-term follow-up in 1200 patients. Obes Surg. 27 (5), 1153-67. Available from: https://pubmed.ncbi.nlm.nih.gov/27783366/
  6. Chung, AY; Thompson, R; Overby, DW; Duke, MC & Farrell, TM. (2018). Sleeve gastrectomy: Surgical tips. J Laparoendosc Adv Surg Tech A. 28 (8), 930-7. Available from: https://pubmed.ncbi.nlm.nih.gov/30004814/
  7. Crawford, C; Gibbens, K; Lomelin, D; Krause, C; Simorov, A & Oleynikov, D. (2017). Sleeve gastrectomy and anti-reflux procedures. Surg Endosc. 31 (3), 1012-21. Available from: https://pubmed.ncbi.nlm.nih.gov/27440196/
  8. Guirat, A & Addossari, HM. (2018). One anastomosis gastric bypass and risk of cancer. Obes Surg. 28 (5), 1441-44. Available from: https://pubmed.ncbi.nlm.nih.gov/29516398/
  9. Kahn, SE; Hull, RL & Utzschneider, KM. (2006). Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature. 444 (7121), 840-6. Available from: https://pubmed.ncbi.nlm.nih.gov/17167471/
  10. Sheka, AC; Adeyi, O; Thompson, J; Hameed, B; Crawford, PA & Ikramuddin, S. (2020). Nonalcoholic steatohepatitis: A review. JAMA. 323 (12), 1175-83. Available from: https://pubmed.ncbi.nlm.nih.gov/32207804/
  11. Wolfe, BM; Kvach, E & Eckel, RH. (2016). Treatment of obesity: Weight loss and bariatric surgery. Circ Res. 118 (11), 1844-55. Available from: https://pubmed.ncbi.nlm.nih.gov/27230645/

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