With the improvement of people’s living standards, obesity is becoming an increasingly obvious threat to human health, which not only disrupts the regulation of blood sugar, blood lipids and blood pressure, but also brings about a high incidence of respiratory sleep apnea syndrome, cardiovascular accidents and other diseases. Sixty-five percent of Americans are obese, and 90 percent of all diabetes patients in the United States are overweight, so it is clear that obesity and diabetes are inextricably linked.
As we all know, the treatment of diabetes has the famous “five carriages” doctrine. That is, health education, diet control, physical activity, blood glucose monitoring and drug therapy. In the last 30 years, a new form of diabetes treatment, surgery, is being perfected, bringing benefits to more and more obese diabetic patients.
The surgical treatment of diabetes is a purely accidental discovery. After performing gastric bypass surgery on morbidly obese patients, foreign scholars found that patients with preoperative combined diabetes showed significant improvement in blood glucose levels after surgery, and some even no longer needed to continue taking glucose-lowering medications. Initially, it was thought that weight loss led to increased insulin sensitivity, resulting in remission in diabetic patients. With the development of scientific research, scholars found that numerous endocrine hormones exist in the gastrointestinal tract, which are involved in the regulation of blood glucose and lipid metabolism. After gastrointestinal surgery, the number of hormones such as glucagon-like peptide, lipocalin and insulin receptor increases, and their glucose-lowering effects are significantly enhanced.
For example, 19 diabetic patients underwent partial gastrectomy for gastric ulcer or gastric cancer. After the surgery, 10 patients’ blood glucose dropped to normal, and the remaining 9 patients’ insulin dosage was greatly reduced, and such glucose-lowering effect continued until 5 years after the surgery. In addition to this, postoperative remission of hypertension ranged from 43-83%, improvement in dyslipidemia from 59-97%, and weight loss from 47-70%. It is evident that surgical treatment not aimed at weight loss can also lead to better control of diabetes, which provides a solid theoretical basis for surgical treatment of diabetes.
This type of surgery is customarily called weight loss surgery, which mainly includes gastric bundle plasty, gastric bypass surgery, biliopancreatic diversion and so on, with low surgical risk, low postoperative complication rate and improved long-term quality of life after surgery. The United States is a large obese country, calculated by the body mass index MBI (weight Kg / height 2m), between 30-35 is mild obesity, between 35-40 is moderate obesity, and over 40 is severe obesity. If the MBI exceeds 45, life expectancy will be shortened by 8-13 years. In 2007 alone, close to 200,000 people in the United States underwent weight loss surgery.
For this reason, in 2008, the American Association of Clinical Endocrinologists and the Obesity and Metabolic Diseases Society jointly issued guidelines for bariatric surgery, specifying that it can be applied to type 2 diabetic patients with MBI over 35 who are poorly controlled by medications.
The Chinese obesity is mainly abdominal obesity, and the grading standard is also different from that of the United States, BMI between 26-28 is mild obesity, between 28-30 is moderate obesity, and over 30 is severe obesity. Patients can receive surgical treatment for diabetes.
It is worth noting that the surgical treatment of diabetes is not a permanent solution. After the surgery, patients still need to receive guidance from endocrinologists, nutritionists and rehabilitation specialists, and under the premise of maintaining a good lifestyle and regular diet, they can achieve long-term control of blood glucose, improve metabolic disorders and reduce the occurrence of long-term complications without drugs or with fewer drugs.