Bariatric Surgery: A Treatment for Diabetes?

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Nearly 40 million persons in the United States are affected by diabetes. Incredible strides have been made in the treatment of diabetes in recent years, and more medication options are available today than ever before. However, there are also surgical treatments available to improve BG control, reduce weight, and may even result in diabetes remission. This treatment is bariatric surgery. When is bariatric surgery the right treatment for diabetes? How does it work? What kind of results are expected? Find answers to these questions here.

Recommendations for Treatment

Surgeons performing stomach surgery realized improvements in BG control as early as 1995. However, it was not until 2011 that the American Diabetes Association (ADA) recommended bariatric surgery as a treatment for diabetes. Although the ADA and other expert guidelines recommend bariatric surgery as an option for persons with diabetes and a Body Mass Index (BMI) of 30 or higher, most insurance companies require patients with diabetes to have a BMI of 35 or higher. Weight reduction after bariatric surgery can range from 25%-45% of total body weight loss within 1 to 2 years after surgery. BG improvement begins within hours after surgery.

How it Works

Improved BG control after bariatric surgery is due to many factors and is much more complex than simply having a smaller stomach and eating less. The most common bariatric surgery procedures include sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPDS), and single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI). The type of bariatric surgery will determine the change in the size of your stomach and possibly a change in the length of your small intestines. After surgery, there is an increase in the production of several hormones that signal to your brain feelings of fullness and improve insulin production and blood glucose control. In addition, the bacteria present in the gut change after surgery, which results in changes in the absorption of nutrients. Insulin sensitivity improves, as do the regulatory effects of the liver on BG. Many of these changes occur in just a few short hours after surgery, and often, patients will be able to return home from the hospital without the need for diabetes medications. Nearly 90% of patients with diabetes who have bariatric surgery will experience improved BG control or diabetes remission after surgery. The rate of diabetes control declines over time after surgery, and relapse of diabetes is not uncommon. Recent studies show that 23-50% of patients continue with diabetes remission at 5 years after surgery. While there is no way to know for sure how each patient will respond, there are some factors that make diabetes remission more likely.

Predictors of Diabetes Remission

There are several factors associated with diabetes remission after bariatric surgery. These include age, years with diabetes, weight, number of medications used to treat diabetes, BG control, and type of surgery.

Age- a younger person is more likely to have greater control of their blood glucose after bariatric surgery. Those persons 40 years or younger have a better chance of diabetes remission. Those 60 years and older are less likely to experience diabetes remission after bariatric surgery.

Duration of Diabetes- The best chance for diabetes remission is in persons who have had diabetes for 6 years or less. Diabetes tends to become more difficult to treat and less responsive to bariatric surgery over time.

Weight- those with higher weights are more likely to see improvement in their diabetes after surgery than those with lower weights. A BMI of 44 or higher is associated with a greater chance of diabetes remission.

Number of Medications: fewer medications needed to control diabetes before surgery is associated with improved diabetes control after surgery. The number of medications and the need for insulin before surgery are associated with lower rates of diabetes remission after surgery.

Glucose control: A controlled BG before surgery also is a better predictor of better glucose control after surgery.

Surgery Type: Roux-en-Y gastric bypass (RYGB) or BPDS is associated with the highest incidence of diabetes remission.

Discussion

Bariatric surgery is a recommended treatment for diabetes in persons with a BMI of 30 or higher. Bariatric surgery improves BG control by many mechanisms, including weight reduction and restriction in food portions. Multiple other changes are also involved, including changes in the absorption of nutrients, gut and brain hormones, gut bacteria, and improved insulin resistance. Improvements in BG control begin within a few short hours after surgery. As a result, some people will leave the hospital without the need for diabetes medications. The predictors of diabetes remission suggest bariatric surgery is most effective when offered early in the disease process and for those with higher weight. While most people with diabetes will experience improved BG control after bariatric surgery, it is important to understand that this can change over time, and not everyone will experience diabetes remission.

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Article written by:

Lori Wenz, RN, MSN, AGNP-C, BC-ADM

Lori Wenz, RN, MSN, AGNP-C, BC-ADM is a national board-certified nurse practitioner who has developed expertise in the treatment of diabetes and obesity. She has a board certification in Advanced Diabetes Management as well as a Certificate of Advanced Education in Obesity Medicine from the Obesity Medicine Association. Ms. Wenz’s experience as a Nurse Practitioner has included Primary Care, Endocrinology, Medical Obesity, and Bariatric Surgery. She currently works at a comprehensive obesity treatment center, a program she developed in collaboration with St. Mary’s Medical Group, St. Mary’s Hospital, and a group of bariatric surgeons in Grand Junction, Colorado. She also works in private practice with Comprehensive Weight Management in California. Ms. Wenz has been an active member of the Obesity Medicine Association since 2017 and currently serves on the CME and Medical Surgical Committees. She has dedicated her career to providing compassionate, evidence-based treatment to patients with diabetes and obesity. Her goal is to help patients make nutrition and lifestyle changes, and incorporate medications when needed, to help reduce weight and improve health. Outside of work, Lori enjoys spending time hiking, kayaking, paddle boarding, reading, and taking walks on the beach with her husband Adam and their two daughters.