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

Ryan H. Fitzgerald, DPM

   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.1

   Furthermore, research has documented that weight loss improves metabolic control in these patients.2 Research also demonstrates that remission of diabetes is possible in those individuals who demonstrate sufficient reduction in body mass index (BMI).1 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.

A Closer Look At The Numbers On Diabetes And Comorbidities

   There are nearly 24 million Americans living with diabetes, approximately 8 percent of the total population. Nearly 6 million of these individuals are undiagnosed.2,3 Current estimates suggest that by 2050, 48 million Americans will have type 2 diabetes.2

   The incidence of type 2 diabetes in adolescents has increased 10 times over the last decade and now constitutes just less than one-third of new pediatric diabetes cases. In contrast, type 2 diabetes accounted for only 20 percent of all pediatric cases a decade ago.2 This is an epidemic of diabetes that we cannot ignore.

   There have been numerous studies that demonstrate the link between diabetes and other medical comorbidities. Of those with diabetes, 60 percent of patients demonstrate one other serious health problem; 33 percent of patients demonstrate two other serious health problems; 10 percent have three other serious health problems, and 7 percent have four or more additional serious health problems.4

   Diabetes is a leading cause of adult blindness, lower limb amputation, kidney disease, nerve damage and cardiovascular disease. Diabetes is particularly common among those patients who are morbidly obese and these patients commonly demonstrate a metabolic syndrome that includes type 2 diabetes, hypertension, hypercholesterolemia and elevated triglyceride levels.

   In addition, this epidemic of diabetes demonstrates significant economic consequences that should be of major concern to both healthcare providers and healthcare consumers.

   The total annual cost of diabetes has been estimated at $174 billion and most experts agree that this value is an underestimate. Of this total, $116 billion constitutes direct medical costs, which are associated with hospital stays, medications and medical equipment. The remaining $58 billion are indirect costs, which include the expense of disability, premature mortality and work loss.4-7 Furthermore, experts suggest that obesity will cost the United States approximately $344 billion in medical related expenses by 2018. This would constitute approximately 21 percent of all healthcare spending.8

   Clearly, the healthcare profession must make significant efforts to address this rising epidemic of diabetes and diabetes-related complications in order to reduce morbidity and mortality in patients living with diabetes, and help reduce the spiraling healthcare costs.

Weighing The Pros And Cons Of Bariatric Surgical Procedures

   When considering bariatric surgical procedures, there are essentially two categories: gastric restrictive procedures and those procedures that introduce an element of malabsorption.

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