Surgery for Type 2 Diabetes
(Based on recent IDF Position statement)
Obesity and type 2 diabetes are serious chronic diseases associated with complex metabolic dysfunctions that increase the risk for morbidity and mortality. It has been estimated that the risk of developing type 2 diabetes is increased 93-fold in women and 42-fold in men who are severely obese rather than of healthy weight.
A position statement from the International Diabetes Federation taskforce states that bariatric surgery constitutes powerful options to ameliorate diabetes in severely obese patients, often normalising blood glucose levels, reducing or avoiding the need for medications and providing a potentially cost-effective approach to treating the disease.
It also states that Bariatric surgery is an appropriate treatment option for people with type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially when there are other major co-morbidities. Surgery is an accepted option in people who have type 2 diabetes and a BMI of 35 or more.
The statement issued also mentions that surgery should be considered as an alternative treatment option in patients with a BMI between 30 and 35 when diabetes cannot be adequately controlled by optimal medical regimen, especially in the presence of other major cardiovascular disease risk factors. For Asians, the BMI cut off is >27.5 kg/m2.
In addition, bariatric surgery has been shown to substantially improve hypertension, dyslipidaemia and sleep apnoea and several reports have documented an improvement of overall survival and specific reduction in diabetes-related mortality.
Bariatric procedures aim to reduce weight and maintain weight loss through altering energy balance primarily by reducing food intake and modifying the physiological changes that drive weight regain. There also appear to be independent metabolic benefits, associated with effects of incretins and possibly other hormonal or neural changes after some surgical procedures, in addition to weight loss. For example, rapid and sustained improvements in glycaemic control can be achieved within days of gastric bypass surgery, before any significant weight loss is evident.
The extent of remission of type 2 diabetes is influenced by the extent of weight loss, weight regain, duration of diabetes, the pre-surgery hypoglycaemic therapy requirements, and the choice of bariatric procedure. In addition each patient‟s commitment to modifying their diet and levels of exercise within a framework of ongoing multidisciplinary care will influence outcomes.