Surgery for Type II Diabetes

Over the last ten years it has been recognised that certain weight loss operations not only help patients lose weight, but also treat type II diabetes, allowing up to 70% of patients achieve diabetic remission and come off all medications. The two operations that work best for diabetic patients are a laparoscopic sleeve gastrectomy and a laparoscopic gastric bypass.

Many people believe that losing weight will help improve your diabetic control, and while this is true, an operation for your diabetes works in more ways than simply helping you lose weight. Both laparoscopic sleeve gastrectomy and bypass change the way your gut (your stomach and intestines) process sugar. After an operation, food that you eat will reach the small intestine quicker than it would before your operation. Your gut, liver and pancreas are all closely linked and work together to process food and sugar. Food reaching your small bowel sooner after eating it, changes the way it is processed by the body. Although we are still working out exactly how this all works, what we do know is that patients wake up after surgery with dramatic improvement in their sugar levels before they have even lost any weight!

The reason for considering surgery is your long-term health. The main concern with having type II diabetes is not the effect your sugar level has on your health today, but that over the next 10-20 years you have a much higher risk of developing heart attacks, problems with your arteries, strokes, nerve problems, kidney problems and eye problems. We now know that having a operation for your diabetes will cut in half your chance of having most of these problems. Microvascular complications (eye, kidney and nerve problems) occur at half the rate in patients who have had surgery compared with those who haven't, and macrovascular complications (heart attacks, strokes and artery problems) occur at only 65% the rate in those who have had surgery compared with those who haven't.

We consider the improvement you get from your operation to have put your diabetes into remission rather than to have completely cured it. Overall it seems that an operation will delay everything with your diabetes by about 20 years. For example instead of needing to start insulin at the age of 65, you may only need to start it at 85, or if you were to suffer kidney problems this may only become a problem when you are 80 rather than when you are 60.

Most people will be advised to stop their diabetic medication after their surgery and to monitor their blood sugar levels. About 30% of people will need to restart a medication but often will find they need less or fewer medications than they did before.

The sooner the better! We know that the sooner you have an operation for your diabetes, the greater the chance of it putting your diabetes into remission. The best results occur in patients who have been diagnosed with diabetes within the last 5-7 years.

Over the next 10 years your HbA1c (a marker often used by your GP to monitor your diabetes) will average 1.5% lower (e.g. 7 instead of 8.5) or 2-2.5mmol/L than it would have otherwise.

The current guidelines suggest that

• If you have been diagnosed with diabetes and have a BMI of 40 or above, you should have an operation for your diabetes rather than starting on medication.
• If you have recently been diagnosed with diabetes and you are having trouble controlling your diabetes with tablet medications alone, and your BMI is 35 or above you should strongly consider having an operation
• If you have a BMI of 30 and above, and are not getting good control of your diabetes with your current treatment, you should consider having an operation.

*if you are of Asian decent you should consider an operation at a lower BMI given genetic differences.

Surgery for diabetes and weight loss is major surgery and does come with a risk of complications. However, surgery now is safer than it ever has been. Key hole (laparoscopic) techniques and better training and experienced staff mean that operations are performed routinely and safely throughout Australia on a regular basis. Having an operation for your diabetes is now as safe as other routine operations performed such as surgery for gallstones.

If you successfully lose weight with your lap band you will see improvement in your diabetes, but it will only be improvement from weight loss. Sleeve gastrectomy and laparoscopic bypass are recommended for diabetes as not only do you get improvement in your diabetes from weight loss, but more importantly you get dramatic improvements from altering the way your body processes sugar.