Can Bariatric Surgery Be A Cure For Type 2 Diabetes In Obese Patients?

In recent years, there have been numerous studies that demonstrate the link between obesity and type 2 diabetes. Several studies have demonstrated that modest weight loss in at-risk patients with impaired glucose tolerance reduces the incidence of new diabetes nearly 60 percent over four years.

Furthermore, research has documented that weight loss improves metabolic control in these patients.  Research also demonstrates that remission of diabetes is possible in those individuals who demonstrate sufficient reduction in body mass index (BMI).  Clearly, weight loss is beneficial in obese patients with type 2 diabetes.

However, such necessary weight loss is difficult to achieve and is perhaps even more difficult to maintain. It is this challenge that has prompted clinicians to seek out alternative treatment options to promote weight loss in this challenging patient population. In this regard, bariatric surgery has shown significant promise.

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Do you discuss weight-loss modalities with your patients?

If so, what do you believe the podiatric physicians role in the management of these conditions?

Ryan,

I routinely discuss and recommend bariatric surgery to my obese patients with DM. Although we haven't figured out the physiology of it, we have more than enough anecdotal data to conclude that, bariatric surgery is the cure for DM type 2.

I've seen it with my own eyes; I have a very good friend, who weighed 350 pounds with insulin-dependent DM type 2. He had a gastric bypass surgery last year, and he got off insulin within a week. Now he is down to his ideal body weight of 170 lb (he is about 5'-8"), and keeping it there for several months now. It's really amazing!

I am so curious about why the one person who voted "no" voted that way? Would they care to come forward and offer their reasoning? I, certainly, am not going to argue but I would like to understand.

I can share with you, that in my experience I had several patients who were able to obtain a bypass, primarily the older Roux-en-Y. While most initially lost a large amount of weight and then regained some, none ever regained their Diabetes.

One patient had what was then considered an experimental surgery, almost 25 years ago. She and her doctor had referred to it as a simple "stomach stapling." Frankly, I didn't see the operative report and I didn't learn of the details and so I don't know if it was just a compartmentalizataion of the existing stomach or not or a connection of the upper portion of the stomach to a distal portion of the small intestine. But regardless, the woman's current chart and notes from her internist indicated that the patient had lost significant weight, in the range of over 100 pounds.

Given that and other patient experiences, I was always an advocate for my patients to receive bariatric surgery. I know that there is the potential for weight regain but I also know that they usually don't regain enough to cause the D2 to return. That can be a gift of life for them.

Isn't that what a doctor is supposed to do for a patient?

I have succeeded in getting patients to the OR for bariatric surgery and seen similar permanent life changing results.

One patient, however died on the OR table and that was tough for the family (and me as I knew him well) and that fact should not be underplayed
.

I don't remember who mentored me to my current mantra but my refrain to morbidly obese patients is that "There is no weight loss method more dangerous to you than the weight you are carrying".

I will add that the greatest success in these areas comes from patients with a strong family and support system and I would resist suggesting bariatric surgery on patients who live alone, have lost a spouse, have no family living close by, etc.

In our institution, the vast majority of the bariatric surgery cases are done with scopes, and they convert the case to a "open" case only when they cannot finish the case because the liver gets in the way etc.

I think they are much more selective on the surgical candidate now, and from what I have heard, the peri-operative mortality rates have gone down dramatically recently. The latest patient that I sent to the bariatric clinic downstairs (I think he weighs 400lb or more) was told to lose 100lb first with diet/exercise before he can undergo the gastric bypass, to make him more "ideal" surgical candidate. 

I agree with your last point. DM type 2 takes 12 years off your life, not to mention the multiple complications (neuropathy, nephropathy, retinopathy etc), so I see absolutely no problem with recommending or suggesting gastric bypass to our morbidly obese patients.

Just my 2 cents... KS. 

I don't usually discuss  bariatric surgery with my over weight patients. I do discuss the benefits of exercise and weight loss and I refer them to a nutritionist. When bariatric surgery comes up I relate an article to them about Doctors in Austraila that go through the motions of doing bariatric surgery while the patient is in a state of hypnosis. The article states that the patients react the same way as if the had the actual surgery.