Diabetes can be cured by Bariatric Surgery!
Diabetes is one of the deadliest diseases of mankind. One major reason why it is so deadly, is because with all the available treatment options, there was no way to cure diabetes.
But now, there are certain types of surgeries which can cure or improve the situation for the morbidly obese patients with Type 2 Diabetes Mellitus. Read on for more information……
Underlying mechanisms in Diabetes
A few short decades ago, it was understood that diabetes results from the loss of a few vital cells in the pancreas – the Beta – cells, to be precise. It was soon also realized that the disease expresses itself only after at least 60 % of the cells are lost – which meant that diagnosing somebody using the standard measures – the response of the blood glucose levels to an oral glucose load – was not useful in the earlier stages when prevention could have some role.
Further research uncovered that there were other factors involved in Diabetes – something called Insulin Resistance; this means that even if the individual is producing enough insulin in response to the glucose in his diet, this insulin is not as effective as it should be in removing glucose from the blood.
Mechanisms of this insulin resistance were worked – out, and it was realized that for obese people – those with a BMI of 30 and above – Insulin Resistance played a far greater role in making them diabetic. In fact, the heaviest of people have only Insulin Resistance as the main reason, so if you could somehow reduce their Insulin Resistance, they may become non-diabetic.
The major reason for Insulin Resistance was obesity itself, and it has been known for quite some time now that reducing obesity is THE MOST IMPORTANT step in curing diabetes. For the people with the most obesity – those with BMIs above 35, surgical treatment to cure their obesity could be life – saving. Different forms of surgeries were invented – the Gastric Bypass, the modifiable gastric banding technique and Sleeve Gastrectomy.
[caption id="attachment_833" align="aligncenter" width="300"] A visual image of the different types of obesity surgeries – the most preferred is the Gastric Bypass[/caption]
But what remained was to find out whether performing any of these surgeries helped these patients to have sustained weight loss as well as sustained cure from diabetes.
The most recent study published by the Cleveland Clinic, Ohio, USA, describes a 5 – year follow up on 217 obese patients with Type 2 Diabetes Mellitus, who underwent one of the surgeries in the years 2004 – 2007.
About 25 percent of the patients had complete “cure” of their diabetes by the study’s end, meaning that they had normal glucose metabolism measures for at least a year without taking medication.
Another 26 percent had a partial remission, meaning they had reached blood glucose levels higher than normal but below those deemed “diabetic” without taking medication for at least a year.
Even in those patients who did not achieve a long-term remission, there were fewer patients taking insulin.
About 20 percent of patients had a recurrence of their diabetes, and these patients were more likely to have had longer-standing diabetes and to have regained weight post-surgery.
About 34% improved (>1% decrease in glycated hemoglobin levels without remission) from baseline and 16% remained unchanged.
Factors that determined a response:
The authors suggest that the following factors predict which patient will go into long- term diabetes free state ( remission):
- Shorter duration of T2DM
- Higher long-term (sustained) excess weight loss
In about 19% there was an initial remission of Type 2 Diabetes, but then diabetes recurred – this was due to longer duration of diabetes prior to surgery, and not enough weight loss following surgery, or regaining of weight after an initial loss.
The effects of the surgery on control of cholesterol and other lipids were also significant, and some of the early effects of diabetes on the kidney also regressed.
Bariatric surgery can induce a significant and sustainable remission and improvement of Type 2 Diabetes Mellitus and other metabolic risk factors in severely obese patients. Surgical intervention within 5 years of diagnosis is associated with a high rate of long-term remission.
There are some downsides to bariatric surgery as well, and I will talk about this in a future post.
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