Type 2 diabetes: How gastric surgeries can help people with diabetes and obesity

Weight-loss surgery addresses type 2 diabetes in two key ways: It aids individuals in reaching a healthier body mass index (BMI) by limiting their food intake and reducing the amount of calories their body can absorb.
Type 2 diabetes

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Bariatric surgery

The medical name for surgical methods designed to treat obesity and diseases associated to obesity is bariatric surgery, often known as metabolic surgery or weight loss surgery. After bariatric surgery, long-term weight loss may be attained by reducing fat absorption, physically shrinking the stomach, or changing gut hormones. Roux en-Y bypass, sleeve gastrectomy, and Mini gastric bypass are examples of standard-of-care surgeries that result in weight loss primarily through changes to gut hormone levels that regulate hunger and fullness, thereby establishing a new hormonal weight set point.

Bariatric surgery is the most effective treatment for weight loss and lowering problems in those who are severely obese. Bariatric surgery was linked to a lower all-cause death rate in obese persons with or without type 2 diabetes, according to a meta-analysis published in 2021.In addition, this meta-analysis discovered that the median life expectancy gain for obese persons with diabetes who underwent bariatric surgery was 9.3 years greater than that of those who received standard (non-surgical) care; in contrast, the gain was 5.1 years longer for obese adults without diabetes. Less than one in 1,000 people will die in the time after surgery. According to a 2016 review, bariatric surgery could lower an obese person’s all-cause death by 30 to 50%.

Additionally, bariatric surgery may reduce the chance of developing certain diseases, and risk factors for cardiovascular disease, fatty liver disease, and diabetes control.

Applications in medicine

The most successful weight loss treatment for obesity that has been shown to produce long-lasting results is bariatric surgery. In addition to decreasing weight, the process lowers the risk of depression syndromes, fatty liver disease, cardiovascular diseases, and type 2 diabetes, among other conditions. Despite being frequently successful, there are a number of obstacles to shared decision making between the patient and the healthcare provider, such as inadequate insurance coverage or comprehension of how it works, ignorance of procedures, inconsistencies with organizational priorities and care coordination, and resources for those who require surgery.

Type 2 diabetes mellitus:

Research on bariatric surgery for type 2 diabetes (T2DM) in the obese population reveals that 33% of patients sought surgery only to lose weight, whereas 58% of patients prioritized improving their diabetes.Although losing weight is crucial for managing type 2 diabetes, maintaining these gains over the long term is difficult; between 50% and 90% of individuals have difficulty achieving sufficient diabetic control, indicating the need for alternate therapies. According to research, 85.3–90% of patients with type 2 diabetes were able to achieve resolution following bariatric surgery, as indicated by drops in HbA1C and fasting plasma glucose levels. Remission rates were also reported to reach 74% two years after the procedure.Moreover, there is a distinction in the efficacy between conventional therapies and bariatric surgery. 

Bariatric surgery has been linked to relative risk reductions of 61%, 64%, and 77% for the development of type 2 diabetes, hypertension, and dyslipidemia, respectively. These findings demonstrate the effectiveness of bariatric surgery in both preventing and treating chronic obesity. A patient’s age, the length of their diabetes, their waist circumference, their current diabetes management strategy, and sufficient blood sugar control are all predictors of post-operative diabetes resolution.

Additionally contributing to the decrease in drug use is bariatric surgery. In the post-operative period, 76% of patients stopped taking insulin, and 62% of patients no longer needed to take any T2DM drugs.

For those with obesity and new-onset T2DM, bariatric surgery is also an option, however the degree of improvement might be marginally lower. The International Diabetes Federation Task Force advises bariatric surgery in specific situations, such as when conventional weight loss and type 2 diabetes treatment fail to control a person’s BMI of 30 to 35.

Weight loss:

Malabsorptive techniques have a higher risk profile but, in adults, result in greater weight loss than restrictive treatments. Although gastric bypass surgery may result in the greatest initial and long-lasting weight loss, gastric banding is the least invasive option and may cause fewer issues. It hasn’t been determined that one protocol is better than another. 74.1% for biliopancreatic bypass +/- duodenal switch, 45.9% for gastric banding, 56.7% for gastric bypass, and 58.3% for sleeve gastrectomy are the estimated weight loss (EWL) for each surgical protocol according to a 2019 systematic review. After surgery, despite significant weight reduction, the majority of patients do not become less obese (BMI 25–35), and patients with BMIs over 40 often lose more weight than those with BMIs under 40.

Risks and complications

With bariatric surgery, the overall risk of death is minimal, ranging from 0 to.01%. Surgical experience and training have greatly reduced severe consequences, such as necrosis or stomach perforation. Morbidity after bariatric surgery is likewise minimal, at 5%.Actually, compared to controls, a number of studies have found a lower overall long-term all-cause mortality. Elevated death after surgery may be attributed to the ongoing problems of existing obesity-associated disease, as obese populations remain an elevated risk of disease and mortality relative to the general population even after surgery.

8% of surgeries following adjustable gastric banding, 6% following Roux-en-Y gastric bypass, 1% following sleeve gastrectomy, and 5% following biliopancreatic diversion required reoperations as a result of complications. In a ten-year research, 9% of patients who had a sleeve gastrectomy and 12% of patients who had a Roux-en-Y gastric bypass needed a reoperation after 5 years, utilizing a uniform data model to facilitate comparisons. Comparing both effects to those associated with adjustable gastric banding, there were less of them.

  • Postoperative:

If all goes according to plan, a 2-to 5-day hospital stay is typical after laparoscopic bariatric surgery. As with other surgical operations, there is a chance of pneumonia, which is often less common with minimally invasive procedures, atelectasis (collapse of narrow airways), and pleural effusion (fluid buildup in lungs).

  • Gastrointestinal:

The most frequent side effect, which can happen in as many as 25% of cases, is GERD, particularly following a sleeve gastrectomy.After Roux-en-Y, another common complication of bariatric surgery is dumping syndrome, which can be further divided into early and late dumping syndrome. Dumping syndrome is defined as the rapid emptying of undigested stomach contents. Although it can be uncomfortable,dumping syndrome has been linked to more effective weight loss in some circumstances. Dumping syndrome manifests as nausea, diarrhea, excruciating cramping in the abdomen, bloating, and autonomic symptoms as flushing, sweating, tachycardia, and palpitations. Emptying within an hour after eating, commonly known as early dumping syndrome, is also linked to a sharp drop in blood pressure that can result in fainting.

Low blood sugar that occurs 1-3 hours after a meal is the hallmark of late dumping syndrome, which also manifests as palpitations, tremor, sweating, lightheadedness, and irritability. The easiest way to lessen the effects of dumped syndrome is to eat small meals and stay away from high-fat or high-carb foods.

  • Gallstones:

Following obesity surgery, rapid weight loss may exacerbate the formation of gallstones, particularly between six and eighteen months.The prevalence of symptomatic gallstones following a Roux-En-Y gastric bypass is estimated to be between 3 and 13%.After bariatric surgery, women have been demonstrated to have a greater risk of developing gallstones.

  • Kidney stones:

After a Roux-En-Y gastric bypass, kidney stones are prevalent (prevalence estimates range from 7–11%).

Most popular methods

Sleeve gastrectomy:

Sleeve gastrectomy, sometimes referred to as a gastric sleeve, is a surgical weight-loss technique in which a significant section of the stomach is surgically removed, going along the stomach’s primary curve, to minimize the size of the stomach. giving the stomach a banana-shaped sleeve or tube form Using staplers

The operation is carried out laparoscopically and cannot be reversed. It has been discovered to result in weight loss similar to that of a gastric bypass surgery using Roux-en-Y. Sleeve gastrectomy has a lower incidence of ulcers and intestinal strictures-related gut narrowing than Roux-en-Y gastric bypass; nonetheless, it is less effective in treating type 2 diabetes and GERD.

As of 2021, this was the most often performed bariatric procedure in the United States and one of the two most often performed procedures globally. While it was once believed that the operation only caused weight reduction by shrinking the stomach, more recent studies have revealed that the procedure also alters gut signaling hormones.

Roux-en-Y gastric bypass surgery

During Roux-en-Y gastric bypass surgery, a new gastrointestinal tract link is made between the center of the small intestine and a smaller section of the stomach.

Because a new, limited link has been made, the surgery is a permanent operation that seeks to reduce the absorption of nutrients.The procedure also resets hunger and satiety levels by influencing gut hormones.Following surgery, patients see a reduction in stomach size and a rise in baseline satiety hormones, which aid in helping them feel full on less food.

About 140,000 gastric bypass surgeries were carried out in the US in 2005, making this the most popular weight-loss procedure. However, since 2013, sleeve gastrectomy has been the most popular bariatric treatment, surpassing RYGB.RYGB is still one of the two bariatric procedures that are carried out worldwide the most frequently.

Biliopancreatic diversion with duodenal switch

Although a little less popular bariatric treatment, biliopancreatic diversion with duodenal switch (BPD/DS) is becoming more widely used and has been shown to be effective for long-term weight loss.

There are several steps in this process. A sleeve gastrectomy (refer to the section above) is done first. Due to the physical reduction of the stomach size, this treatment has a permanent effect on food consumption. The alimentary limb is then formed by cutting the stomach’s connection to the upper portion of the small intestine and joining it to the ileum, a longer segment of the intestine. The remaining segment of the distal small intestine is subsequently utilized to create an opening that transports digestive secretions from the pancreas and gallbladder to the alimentary branch.

The change in gut hormones that regulate appetite and fullness, the physical constriction of the stomach, and the reduced absorption of nutrients are the main causes of weight loss after surgery. When it comes to long-lasting weight loss and the resolution of type 2 diabetes, BPD/DS works better than sleeve gastrectomy and Roux-en-Y gastric bypass.

Recuperation/ Recovery

Over the years the recovery after bariatric surgery has improved drastically. Within 4 to 5 hours after the surgery the patient is made to walk. By the end of the  next day the patien can be discharged and resume work in a day or two. 

Adequate hydration is very important  and needs to be kept in mind to have  liquids frequently as one cannot drink water quickly in big gulps after the surgery. 

Supplements , proteins powders  and physical activity as advised are very important in having a holistic weightoss. 

Not to forget that frequent visit to the doctor, nutritionist will help you in the long run.

Picture of Dr. Tulip
Dr. Tulip

Dr. Tulip is an advanced laparoscopic and Bariatric surgeon practicing in Bangalore at TODS- Dr. Tulips Obesity and Diabetes Surgery Centre

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Amera Begum
Amera Begum
Dr Tulip and Dr kavita are Amazing. I had sleeve gastric bariatic surgery 5days ago and i lost 4 kgs. I am extremely grateful that Dr Tulip has given me new life new start and Dr Tulip staff also extra carring like i feel im not hospitalized i feel im in cradle . Special thanks to sister Tanu shree ,kerala sister and Bengali brother and once again Dr Tulip and Dr kavita thank you🌹🙏🌹 lots of love you ❤❤❤Drs
Nalini Narayan
Nalini Narayan
Dr. Tulip and Dr. Kavita are amazing. I had a gastric bypass surgery last year and have lost more than 40 kgs. I am extremely grateful that Dr. Tulip has given me new lease of life .Her post operative care and follow ups are fantastic. Thank you Drs.
D.s Suma
D.s Suma
DR.Tulip madam and Kavitha madam were amazing I Had a gastric bypass surgery last month I reduced 10 kgs of weight much more to go I started my second life with this Iam very grateful to dr. Tulip
Sai kiran Reddy
Sai kiran Reddy
After trying for a baby for 7 long years, bariatric surgery helped me. I conceived a year ago and and am a proud mother after shedding 30 kilos
Sankarsh rakesh
Sankarsh rakesh
Huge tummy sagging I had. Confused to do lipo or tummy tuck. Finally did tummy tuck , have flat tummy I dreamed. . Thanks to Dr Tulip and team.
Mahadev Prasad S
Mahadev Prasad S
Lost 20kgs in 4 months for wedding , but also regained 4kgs within 2 months. What doctor told is right only. I should have done Stapler surgery
Anuradha Suryakanth
Anuradha Suryakanth
Gastric bypass, a very wonderful surgery that my uncle underwent. I could notvsee him suffer, his diabetes was uncontrolled, he could not sleep without a CPap machine , breathless after taking few steps. But 4 months since surgery, he has lost 32 kgs, insulin has stopped, only one diabetes medicine he is taking. He no longer uses CPAP machine. He has become positive once again. Thanks to Dr Tulip and team for all the guidance before, during and after surgery. My uncle is in safe hands
Aryan Vishnu
Aryan Vishnu
10 minutes and swalow balon done. I have no discomfort and tummy feeling full. Nevery knew it was really so smooth. Hope I lose 17kgs.