Finding a cure for type 2 diabetes is one of the paramount goals of medical researchers today, worldwide. Published this week, new clinical guidelines announce a radical approach to the treatment of this pervasive condition. A journal of the American Diabetes Association, Diabetes Care, proposes that bariatric surgery now involve manipulation of the stomach or intestine as part of standard procedure for qualifying patients. This development evolved from a number of clinical trials, all demonstrating that gastrointestinal surgery improves blood-sugar levels more efficiently than pharmaceutical intervention or lifestyle changes, and in many cases leads to remission of the disease itself.
Endorsed by 45 professionals worldwide, “These recommendations arguably signify the most radical departure from mainstream approaches to the management of diabetes since the introduction of insulin in the 1920s” (Francesco Rubino, nature.com). With the number of adults with diabetes worldwide quadrupled from 108 million in 1980 to 422 million in 2014, there is little wonder that research of this magnitude is catching fire.
Type 2 Diabetes Can Be Treated with Weight Loss Surgery
Approximately 90% of adults with diabetes worldwide have type 2, which frequently causes blindness, kidney failure, nerve damage, heart attack, stroke, and amputations. Of these, less than 50% are able to control their blood-sugar levels with diet, exercise, and/or medications.
Bariatric surgery offers a growing variety of options for obese patients with co-morbidities, including type-2 diabetes and related conditions. This type of surgery can involve the removal of part of a person’s stomach, dividing the gut in two and rerouting the small intestine to the upper section, as in a gastric bypass procedure. The new guidelines resulting from extensive clinical trials reveal that metabolic surgery, like gastric bypass, could be considered specifically for the treatment of diabetes in individuals have have struggled to manage their blood sugar and whose BMI is greater than 30. The research further clarifies that the gastrointestinal tract is a significant biological target for diabetes-treating interventions.
The Clinical Trials
These ground breaking conclusions have evolved from a massive body of work, including 11 randomized clinical trials conducted by surgeons and researchers over the past 10 years. The patients in these studies were categorized into two groups: those whose diabetes went into remission after treatment, or those whose blood-sugar levels stabilized with reduced amounts of medication, exercise, and/or a calorie-controlled diet.
Other findings include those derived from non-randomized studies featuring patients who underwent surgery, matched with subjects treated using standard interventions. These suggest that surgery may, in many cases, reduce diabetes, heart-attack, and stroke-related mortalities.
While cost is currently a concern for patients seeking to undergo bariatric surgery, multiple economic analyses indicate that, because of these myriad health benefits, surgery costs may be regrouped within two years simply through reduced medication and care expenditures.
Changing Minds, Improving Treatment
The ramifications of the new guidelines stretch far beyond the patients who choose to obtain surgery. Individuals who are just beginning their weight loss journey may be heartened by the idea that surgery is an option if diet, exercise, and medication fail, and that remission of their type-2 diabetes is a real possibility for them. Providers and patients alike may approach the entire treatment process, from creating a diet plan to following through with surgery with more rigor, aware that complete attempts at each level are required before the final step, surgery, is possible.
In addition, upfront costs for surgery currently run patients and/or insurance companies $20,000 – $25,000 in the United States, making bariatric procedures an unlikely solution for the current type-2 diabetes epidemic. However, if costs were grouped and reduced, surgery could be included as a viable option for qualifying patients and would re-shape diabetes care, worldwide.
We are thrilled to hear this news and excited for the hope it brings our patients. Are you struggling with your weight and/or type-2 diabetes? We’d love to have you in to talk more about solutions, and to empower you to take the steps that make the most sense to you.