Diabetes/ Metabolic Surgery

In addition to weight loss, bariatric surgery has been noted to improve type II diabetes mellitus (T2DM), hypertension, and hyperlipidemia amongst a variety of other medical problems. Metabolic surgery is the application of bariatric procedures (adjustable gastric banding, sleeve gastrectomy, gastric bypass, and duodenal switch) for the metabolic benefits that the procedures offer. It is a new and exciting field that is rapidly growing as we learn more and more about the benefits that patients experience post-operatively.

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. The primary goal of treatment is to reduce the risk of heart disease and diabetes.

Modest weight loss is known to improve medical problems such as high blood pressure and diabetes. Initially, the effects of bariatric surgery were thought to be primarily through weight loss. However, many patients experience significant improvement in diabetes control immediately after surgery, before any significant weight loss has been achieved. This observation has led to numerous studies to identify the underlying cause of this effect. Several randomized trials have now shown that all of the commonly performed bariatric operations cause far greater T2DM remission than do medical and lifestyle interventions.

While studies are still ongoing to identify the exact mechanism for such dramatic improvement, clinical application of the procedures has become commonplace. 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 patients. 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 cardiovascular disease (CVD) risk factors, CVD events, cancer and mortality.

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.