recommendations for the treatment of type 2 diabetes. According to both the National Institutes of Health and the American Diabetes Association, bariatric surgery is recommended for all individuals with a BMI of 35 or more who have type 2 diabetes -without exceptions. Based on research that shows remission of diabetes even among lower-BMI individuals after metabolic surgery, the ADA also recommends bariatric surgery for individuals with BMI 30-34 when medications are not fully controlling the blood sugar. Up until recently, most cases of type 2 diabetes have been managed with diet, exercise, insulin therapy and other medications. But the American Diabetes Association (ADA) now believes there is a better and more permanent solution for people with diabetes that often replaces injectable and oral medication: metabolic surgery, also known as weight-loss surgery. More doctors are embracing the ADA’s position on metabolic surgery as a crucial aspect of diabetes care. Numerous studies, going back decades, demonstrate that a high percentage of individuals experience complete remission or reduction in severity of their type 2 diabetes after sleeve gastrectomy, which removes 70 to 75 percent of the stomach and forms the remaining portion into a slender tube. Traditionally, sleeve gastrectomy has been used to prompt significant, sustainable weight loss by altering metabolic hormones, limiting how much food a person can eat and creating a sense of fullness faster. As patients lose weight, they often experience a resolution or elimination of obesity-related health problems, such as heart disease, stroke, high blood pressure, osteoarthritis, sleep apnea and diabetes.
How Does Metabolic Surgery Resolve Diabetes?Laparoscopic sleeve gastrectomy is a 45-minute procedure that changes the underlying hormones that regulate blood sugar and metabolism, resulting in a “re-set” that lowers body weight and blood sugar. In addition to weight-related mechanisms, some of the identified mechanisms of action in resolving diabetes include:
- Increased secretion of glucagon-like peptide-1 leading to hyperinsulinemia and early normalization of glucose levels.
- Enhanced peripheral tissue sensitivity to insulin.
- β-cell sensitivity improves at 12 months and after the loss of approximately 33 percent of excess weight.