Today I want to talk about the most recent 'cure' for type 2 diabetes. A lot has been in the media regarding the benefit of gastric bypass surgery and its ability to 'make diabetes go away'. I think it is really important to make sure we have the facts straight about weight loss surgeries for type 2 diabetes.
Facts about weight loss surgeries
First – not all weight loss surgeries are created equal. Second – not everyone is a candidate for weight loss surgery. And third – not all patients with Type 2 diabetes who have undergone weight loss surgery are 'cured' of their diabetes.
Let’s get the facts:
Fact 1 - Which weight loss surgeries are currently available in Canada?
Fact 2 – Who are the candidates for weight loss surgery?
Fact 3 – What is the evidence that type 2 diabetes can be 'cured' with weight loss surgery?
It is important to realize that for healthy living, there is no easy fix. For many people living with Type 2 diabetes, being overweight has been a life-long problem, made worse after the diagnosis of diabetes because of the treatments used to lower blood glucose levels.
If someone is contemplating having surgery to lose weight, they need to know all the facts. There are currently three different surgeries performed in Canada. Not all are paid for by the government and the individual must show determination in lifestyle changes prior to receiving the surgery. To be eligible for surgery, evaluation from the healthcare team will determine medical need, safety for surgery, mental status about the surgery and lifestyle behaviors.
Obesity is often referred to in terms of BMI (body mass index), not just in weight. The calculation of BMI is based on weight and height and then we can determine the level of obesity and the risk attached. A certain level of BMI is required to be considered for surgery. It is usually reserved for those with at least a BMI over 35 and in the presence of other complications. Most specifically, only when other weight loss treatments have failed.
Types of weight loss surgeries
The three most common types of surgery are laparoscopic adjustable bands, laparoscopic Roux-en-Y gastric by-pass and a diversion technique involving the small intestine. The banding technique can be performed as an outpatient. Lap Banding controls the amount of food that is eaten, but the success rate of this technique is directly related to making significant changes to lifestyle – eating healthy and exercising. If “bad” food – high fat and high calories are consumed, even in small amounts, weight loss will be slower if at all. Dedication to healthy lifestyle is extremely important. With all three surgeries, that is the case, however the latter two surgeries are a bit more involved and they also tend to have the greater benefit in terms of weight loss and “treating” diabetes.
Can weight loss surgery cure diabetes?
Research continues in this area and consistently is showing between 75 and 95% of individuals are medication-free with normal glucose levels after surgery - depending on which type of surgery. In addition, they can remain in remission for a period of at least 6 years based on a recent long term study of over 400 people. At 6 years following surgery, 62% remained medication-free.
What does remission mean? Diabetes is a life-long disease for which no 'cure' has been found. However, removal of the intake of food for any period of time can normalize blood glucose levels as it is the balance of intake, insulin, activity and medications that is successful treatment of diabetes. When there is no glucose entering the body, there is less work for it to do. When a bypass procedure is performed, fewer calories are able to enter the body. The actual mechanisms of glucose control from the gut could be changed as well, but that is hard to understand. What is the common theme is that when less glucose goes into the body, the better blood glucose control will be.
So is weight loss surgery a 'cure' for diabetes? It may not be a cure but it may help to control blood glucose for a longer time - similar to a very strict diet, good activity plan and weight loss. The latter is just harder to do for a long time.
Will weight loss surgery be standard treatment for diabetes in the future? Hopefully not. Hopefully we can encourage all Canadians to live a healthy life, maintain a normal body weight, and reduce their risk of diabetes! But for some, weight loss surgery may provide the glucose control needed to prevent complications of diabetes. Everyone is different!