Is Bariatric Surgery Viable For Obese Diabetes Patients?

Obesity is a leading risk factor for developing diabetes. People who are obese are more prone to suffering from insulin resistance and inflammation, which leads to high blood sugar levels and causes diabetes. People who continue being overweight with diabetes can adversely affect their diabetes management and increase the risk of diabetes complications. Therefore, maintaining a healthy body weight is crucial to managing diabetes. However, sometimes, diet and exercise are not sufficient to reduce weight. In these cases, weight-loss surgeries, also called bariatric surgeries, can vastly benefit.

How Does Bariatric Surgery Help Manage Diabetes?  

Bariatric surgery is a surgical procedure that helps a person lose weight. It changes their digestive system, typically by making their stomachs smaller or reducing the ability of small intestines to absorb calories from the food. 

Apart from weight loss, bariatric surgeries are also beneficial in boosting metabolic activities and improving insulin sensitivity in the body. They also help lower cholesterol levels, regulate high blood pressure levels and enhance kidney functions, thereby reducing the risk of diabetes complications. Therefore, many healthcare professionals often recommend bariatric surgery for diabetes patients who are also obese.    

Types Of Bariatric Surgery

There are many methods of bariatric surgery. Some of the most commonly used procedures are:

Laparoscopic Roux-en-Y Gastric Bypass:

In this procedure, a small stomach pouch is created to limit the food you can eat. Then, this pouch is attached to the lower part of the small intestine to reduce the amount of time the food spends in the small intestine. As the food spends less time in the intestine, the absorption of food is limited, and weight is controlled. 

The changes created in this procedure also tend to affect the way the gut and pancreas interact, and therefore, help to manage diabetes even before weight loss is achieved. 

Laparoscopic Sleeve Gastrectomy (LSG):

In LSG, the size of the stomach is reduced to control the food intake. This procedure usually takes only one night, allowing the patient to get back to work within three to four weeks. LSG is a comparatively easy method of bariatric surgery and is generally preferred for patients with heart or lung problems.

Laparoscopic Adjustable Gastric Banding:

In this procedure, the doctor does not cut your stomach. Instead, they make a small incision in the abdomen and insert a laparoscope to attach an inflatable band to the upper part of the stomach. The tiny pouch so created fills up fast when you eat food and helps you feel full quicker. 

What Are The Benefits Of Bariatric Surgery In Diabetes?

There are many long-term benefits of bariatric surgery, such as improved symptoms of type 2 diabetes, controlled blood pressure levels and low risks of heart and kidney diseases. It is also known to relieve joint and body pain, boost mental health and reduce the body’s requirement of insulin and other diabetes medications. Therefore, now bariatric surgery is increasingly recommended by healthcare professionals to obese diabetes patients. 

However, to attain the benefits of bariatric surgery for a long time, you must continue to visit your doctor regularly after the surgery. Your healthcare team will help monitor your body weight and screen for any complications. It is also important to continue living a healthy lifestyle. You must eat a low-calorie diet and exercise regularly to manage your weight and diabetes well. 

What Are The Risks Associated With Bariatric Surgery?

Some risks associated with the surgery are:

• Dumping syndrome, which includes abdominal pain, sweating, nausea and vomiting after eating
• Blockages in the intestine
• Leaks in the gastrointestinal tract
• Development of gallstones and kidney stones
• Reaction to anaesthesia
• Damage to other organs during surgery
• Inability to absorb nutrients, causing malnutrition
• Bleeding and formation of blood clots 
• Infections

Who Can Opt For Bariatric Surgery?

Although bariatric surgery is highly beneficial, it is usually the last resort for weight loss. Before opting for bariatric surgery, doctors generally recommend losing weight by changing the diet, using medications or modifying the exercise routine. If these methods do not work, then only they suggest bariatric surgery. The individual risks of the surgery also vary from person to person. Therefore, your healthcare team should also assess them before making a decision.

Usually, bariatric surgery is recommended for diabetes patients whose BMI are:

• over 40, even when their blood sugar levels are well controlled
• between 35 and 39.9 and they are not able to control diabetes even with medications
• between 30 and 34.9 and they have not only uncontrolled diabetes but also major obesity-related health conditions 

Doctors generally do not recommend this surgery for people with:

• any inflammatory condition in the gastrointestinal tract
• serious heart diseases, portal hypertension or a recent episode of heart attack  
• history of bowel surgeries or trauma
• serious lung diseases
• allergy to any material that will be used during surgery
• serious illnesses such as cancer and pancreatitis
• unstable mental health condition

Takeaway

Bariatric surgery is a viable option for diabetes patients who are also obese. However, you should only opt for it when all the other weight-loss methods are not working for you. The risk factors also differ from person to person. Therefore, consult your doctor and assess the pros and cons of bariatric surgery before making a decision. 

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3102524/
2. https://www.frontiersin.org/articles/10.3389/fendo.2020.525909/full
3. https://www.medicalnewstoday.com/articles/bariatric-surgery-type-2-diabetes
4. https://my.clevelandclinic.org/health/treatments/21153-bariatric-weight-loss-surgery-for-treating-diabetes
5. https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/weight-loss-surgery