Diabetes And Metabolic Surgery

Diabetes is a complex disease which results from the body’s inability to create or properly use insulin. A hormone produced by the pancreas, insulin, helps the body convert sugar, starches, and other food into energy. If the body doesn’t make enough insulin or if the insulin doesn’t work the way it should, glucose (sugar) cannot enter into the body’s cells. Instead, glucose remains in the bloodstream, raising the blood sugar level and ultimately causing diabetes.

If not managed properly, diabetes can become a life threatening disease. People with diabetes face higher risks for heart disease, kidney failure, blindness, amputations, and other conditions. People suffering from diabetes are twice as likely to die prematurely than those who do not have it.

Types of Diabetes

Type 1 Diabetes

Formerly called juvenile diabetes, type 1 diabetes is an autoimmune disease that results from the body’s failure to produce insulin. The disease occurs when the body’s own immune system destroys the pancreatic cells that produce insulin. Type 1 diabetes usually develops before age 20 and is typically first diagnosed in children, teenagers, or young adults. This form of diabetes accounts for about 10% of all diabetes cases.

Type 2 Diabetes

Accounting for about 90% of cases, type 2 diabetes used to be called adult-onset diabetes. Type 2 diabetes results from insulin resistance, a condition in which the body fails to properly use insulin. This form of diabetes is often associated with being overweight or obese. While type 2 diabetes typically develops during adulthood, the increase in childhood obesity rates has led to a growing number of children with type 2 diabetes.

Gestational Diabetes

A less common form of the disease is gestational diabetes, which strikes about 4% of all pregnant women. Like type 2 diabetes, gestational diabetes is associated with being overweight or obese.  Although this kind of diabetes usually disappears after the mother gives birth, the disease places women at a higher risk of developing type 2 diabetes later in life. Gestational diabetes occurs when the mother’s body is unable to produce and use the additional insulin required to support pregnancy. If the disease remains untreated, the baby’s pancreas will begin to produce the extra insulin. This insulin reduces the high glucose levels in the bloodstream by storing the excess energy as fat, which is why many women with gestational diabetes give birth to babies weighing more than nine pounds.

Pre-Diabetes and Metabolic Syndrome

Physicians now recognize a fourth form of the disease known as pre-diabetes. With pre-diabetes, blood glucose levels are higher than normal but not quite high enough for a diagnosis of diabetes. Researchers estimate an additional 16 million Americans have pre-diabetes. Unlike diabetes, which has no cure, pre-diabetes can be reversed through a combination of increased physical activity and weight loss.

Pre-diabetes is often seen as part of metabolic syndrome.  Metabolic syndrome is the combination of several medical problems associated with morbid obesity: high blood pressure, glucose intolerance/insulin resistance, excess body fat and high cholesterol. Identifying metabolic syndrome is important because the syndrome increases the risk for cardiovascular disease, stroke, type 2 diabetes, kidney disease, and other problems. People with metabolic syndrome are twice as likely to develop heart disease and five times as likely to develop diabetes as those who don't have metabolic syndrome.

Metabolic Surgery

Metabolic surgery is the application of bariatric procedures (adjustable gastric banding, sleeve gastrectomy, gastric bypass, and duodenal switch) to improve conditions like type II diabetes, pre-diabetes and metabolic syndrome.

Originally, it was believed that bariatric procedures helped people with metabolic conditions simply through weight loss.  We now know that many people experience significant improvement in their diabetes control immediately after surgery, even before any significant weight loss has been achieved.  The exact mechanism for this result is still being studied, but several randomized trials have now shown that all of the commonly performed bariatric operations cause far greater type 2 diabetes remission than do medical and lifestyle interventions.

The most pronounced effects are seen after gastric bypass and duodenal switch procedures, which result in improvement or resolution of diabetes in greater than 80% of people. The sleeve gastrectomy, while a newer procedure, is also proving to have a significant impact on the treatment of diabetes.

Improvements are not limited to diabetes, however. A long term study comparing obese patients who underwent surgery with those who did not showed that surgery is associated with major reductions in heart disease risk factors, heart attacks, cancer and overall risk of death.

As we obtain more information about the effects of metabolic surgery, there is growing enthusiasm that we can now offer safe and effective treatment for the management of chronic medical problems.