Why Do We Underestimate The Risks of Type 2 Diabetes Causing Nephropathy and Mortality?

Why do the vast majority of people with type 2 diabetes, and their doctors for that matter, vastly underestimate the risks of continuing to live with diabetes under medical management and of not having surgery? Perhaps because the risks are playing out over time in slow motion. Diabetes shortens our lifespan by an average of 8.5 years when under non-surgical management. In the U.S., over 1.6 million people die every year directly because of diabetes, and it contributes to a large number of deaths beyond that. But those numbers are a bit abstract and hard to make sense of.
Let’s look at it a bit differently. For example, the risk of progressing to development of diabetic nephropathy – a serious kidney disease caused by diabetes’ damage to the small vessels of the kidneys – is over 22% in 6.7 years, according to a very large published study of over 17,000 people with diabetes shown below1. That boils down to an annual risk of over 3 in 100. Metabolic surgery dramatically reduces the risk.
For some perspective, your chance of being killed in an airplane crash is about 1 in 11 million. So maybe you just don’t worry about that one. Or maybe you still get a little nervous on take-off?
Your annual risk of dying from the flu in the U.S. is about 1 in 36,000. The CDC recommends you get a vaccine for it.
Your annual risk of being killed in a car crash is about 1 in 5,000. And there is a good chance you wear a seat belt and drive with an airbag.
The annual risk of dying from type 2 diabetes and its complications is around 1 in 188 with modern medical management alone. (It is actually higher for younger people under 60 years old with type 2 diabetes.)
And, if you have type 2 diabetes now, the chance that you will develop diabetic nephropathy this year is about 1 in 33.
The take-home message is that most people, and most doctors, don’t worry nearly enough about the relatively high risks of living with type 2 diabetes and the risks of not having surgery to treat it. Metabolic surgery is recommended by the American Diabetes Association for patients with type 2 diabetes and an elevated BMI. Numerous large-scale population, cohort, and prospective, randomized studies have shown large reductions in risk with metabolic surgery.
Overestimating risk
In contrast to the serious underestimate of risk that most people apply toward their type 2 diabetes, most people vastly overestimate the risks of metabolic surgery. Today the risks of serious complications and mortality from metabolic surgery are on par or lower than those of Caesarian section, knee repair, gallbladder removal and hernia surgery.
In a large published study of 47,000 gallbladder procedures, the 30-day mortality risk was around 1 in 6652. In our center the 30-day mortality risk is around 1 in 2,000. In large data sets, the mortality risk of sleeve gastrectomy in the U.S. is around 1 in 1,000. These figures are also very similar to the baseline mortality risk of the population.
The risk of kidney failure, blindness, heart attack, and death all drop considerably when individuals with type 2 diabetes undergo metabolic surgery. Laparoscopic sleeve gastrectomy is a 45-minute procedure with 4 small Bandaids that results in a large scale risk reduction for individuals with type 2 diabetes.
Before and After Image of Patient from Sasse Surgical
References:
1.     Billeter, A.T., Scheurlen, K.M., Probst, P., Eichel, S., Nickel, F., Kopf, S., Fischer, L., Diener, M.K., Nawroth, P.P. and Müller‐Stich, B.P., 2018. Meta‐analysis of metabolic surgery versus medical treatment for microvascular complications in patients with type 2 diabetes mellitus. British Journal of Surgery, 105(3), pp.168-181.
2.     Sandblom, G., Videhult, P., Crona Guterstam, Y., Svenner, A. and Sadr‐Azodi, O., 2015. Mortality after a cholecystectomy: a population‐based study. Hpb, 17(3), pp.239-243.
3.     O'Brien, R., Johnson, E., Haneuse, S., Coleman, K.J., O'Connor, P.J., Fisher, D.P., Sidney, S., Bogart, A., Theis, M.K., Anau, J. and Schroeder, E.B., 2018. Microvascular outcomes in patients with diabetes after bariatric surgery versus usual care: a matched cohort study. Annals of internal medicine, 169(5), pp.300-310.