Type 2 diabetes is a condition that in the mind of patients is associated with the use of antidiabetic tablets or insulin to treat it. In recent years there has been a shift and change in the guidelines regarding the application of surgical treatment. Metabolic surgery is now the new big weapon in the treatment and even complete cure of type 2 diabetes.
Metabolic Surgery
With the development of obesity surgery, in particular, through gastric bypass surgery in the early 80s, reports of cases of improvement or even treatment of diabetes began to increase significantly. Therefore, it is now documented that changes in the anatomy of the gastrointestinal tract after surgery cause immediate changes in the metabolism of diabetes.
Since understanding the role of the digestive system in the development of diabetes 2, metabolic surgery has now been officially recognized. It is defined as the anatomical modification of the gastrointestinal tract that alters the exchange of cellular signals at the molecular level and leads to an improvement in the body’s energy balance, caloric intake, and metabolic disorders, especially type 2 diabetes.
The results of metabolic surgery are beneficial:
- Greater improvement in sugar control
- Reduction of required drugs
- Reducing the chance of cardiovascular complications
- Reduction of heart attacks, strokes, cancers, and overall mortality
- Greater weight loss
- Better quality of life
Indications for surgery for type II diabetes
As of 2017, 60 endocrinology companies from around the world have adopted surgical treatment as an appropriate practice in people with type 2 diabetes and obesity. A valuable indicator of obesity and metabolic risk is the Body Mass Index (BMI). It is calculated by dividing weight (in kilograms) by the square of height (in meters). Based on BMI, obesity is divided into category 1 for values between 30 and 34.9 kg / m2, category 2 for values between 35 and 39.9 kg / m2, and category 3 for BMI values above 40 kg / m2.
- Metabolic surgery should be recommended for the treatment of type 2 diabetes in people with type 3 obesity.
- It should be recommended in people with type 2 obesity, as long as blood sugar levels are not kept under control with adequate conservative treatment.
- Metabolic surgery should be considered a possible treatment for type 2 diabetes in type 2 obesity, regardless of the treatment regimen.
- Metabolic surgery should also be considered in people with type 1 obesity, as long as blood sugar levels are not kept under control with adequate conservative treatment.
When the patient meets the criteria, the faster the surgery the better. If the surgery is done at an early stage (when patients are taking only antidiabetic tablets) then the cure for diabetes is close to 100%. As the disease progresses, the reserves of the pancreas are depleted and in addition, the complications of the disease are established, which do not regress. A typical example is the damage to the coronary vessels of the heart, with a risk of myocardial infarction.
Surgeries
Regarding the operation, the obesity surgeon based on the characteristics of each patient should choose the most appropriate and safest operation. Of the surgeries available to treat obesity, all contribute to the improvement of type 2 diabetes, however, gastric bypass shows the best and most stable result in controlling blood sugar.
Of the gastric bypass type surgeries, the one that has been constantly gaining ground in recent years is the gastric bypass of one anastomosis (one – anastomosis gastric bypass / OAGB). About 15 years after its first presentation, it is now proven that it has fewer complications than other similar surgeries and even its results seem to last better over time.
Results
It is estimated that 50-80% of those who undergo metabolic surgery show complete remission of diabetes for more than 5 years, without the need for medication. On the contrary, those who do not follow the path of surgery, are forced to increase the dosage of their medication.
Numerous studies have shown that achieving normal plasma glucose levels occurs within just a few days of surgery. Numerous pathophysiological mechanisms operate postoperatively to observe this phenomenon. The main one is the anatomical change of the gastrointestinal tract, which activates the production of hormonal mediators called incretins and increases insulin sensitivity, lowering glucose levels. Also, the change of the microbial population in the gastrointestinal tract of patients after obesity seems to play an important role in the normalization of blood sugar.
All metabolic surgeries are performed laparoscopically or robotically, resulting in faster recovery and lower hospital costs. If they are performed by an experienced surgical team, they are accompanied by excellent results and a very low probability of complications.
Economic analyzes show that, despite the financial cost of surgery, improving diabetes by reducing the cost of both treatment and the problems it can cause makes them economically viable in terms of quality of life in the long run.
