A growing number of medical experts are now endorsing the idea that diabetes surgery should be offered to treat Type 2 diabetes. The surgical techniques used for weight loss have largely concerned either gastric banding, gastric sleave, pancreatic-biliary bypass and gastric bypass. Patients who are morbidly obese are routinely considered for such surgery although nowadays more and more patients who are only moderately overweight consider bariatric surgery as a means of reversing Type 2 diabetes.
The reason for this shift in emphasis is the realization that surgery not only treats diabetes effectively but in many cases puts the diabetes into remission.
The rates of morbidity and mortality directly related to bariatric surgery have also reduced considerably in recent years such that the risks are now equivalent to having keyhole surgery to remove the gallbladder (laparoscopic cholecystectomy).
As clinical research continues to pick up momentum in this area so do the number of different surgical techniques offered to patients. In addition to standard gastric banding and bypass there are also new emerging procedures such as sleeve gastrectomy, and duodenal-jejunal bypass. Recent clinical studies are indicating that approximately 80% of patients improve or resolve their type 2 diabetes after bariatric surgery. We are still awaiting the results of long-term follow up with respect to persistent benefit or complication rates.
So what for the future? The main conclusion is that we need more research. We need to know more about the longer term effects of gastric surgery, we need to know if the so called ‘remission’ of diabetes by these procedures stand the test of time and are not just short term benefits. Finally we need to know more about what type of surgical procedure might be optimum. Some of these discussions and recommendations can be found on www.asmbs.org. This is the website for the American Society for Metabolic and Bariatric Surgery (ASMBS).