According to an epidemiological survey: In 2013, there were 114 million people with diabetes in China, and as many as 493 million people with impaired glucose tolerance. Of these patients, 90%, or nearly 100 million, are type 2 diabetics, a number that far exceeds that of ordinary infectious diseases.
Traditionally, fat is considered a symbol of wealth and a life of prosperity. With the development of society, it seems not difficult to become “rich and famous”. But with the progress of medical research, we all know that only health is wealth and obesity is a disease! A significant portion of type 2 diabetics are overweight, and endocrinologists will advise patients to lose weight. Doctors often use the metaphor of “small horse-drawn car” to describe the ability of the pancreas to secrete insulin in obese people, and their high blood sugar will increase the burden on the pancreas; without active weight loss, the pancreas will remain in a state of overload until it “runs out of gas” and relies on insulin injections to maintain normal blood sugar. At that time, the person’s wasting is a pathological result.
Can surgery also treat diabetes?
Nowadays, in addition to traditional dietary control, regular exercise and medication, diabetes can also be treated through surgery.
”This is not the first time many people have heard that “surgery can treat type 2 diabetes”. The world-renowned Cleveland Medical Center named surgery for diabetes as one of the “Top 10 Medical Innovations” in 2013 and again in 2015.
One study found that surgery can lead to complete remission in 70 to 80 percent of type 2 diabetes cases that meet the surgical indications. Complete remission is strictly defined here, which means that glycemia can be controlled by diet and exercise alone, with glycosylated hemoglobin < 6.5%, fasting blood glucose < 5.6 mmol/L and 2-hour postprandial blood glucose < 7.8 mmol/L, without the need for glucose-lowering medication, and is maintained for more than 1 year after surgery.
The main procedures currently used to treat diabetes include.
1. Sleeve gastrectomy
By removing a portion of the stomach, the volume of the stomach is reduced to control the patient’s food intake, adjust the microbiota in the intestine, down-regulate leptin secretion, and reduce the patient’s desire to eat. Ultimately, it reduces body weight, reduces insulin resistance, and allows blood sugar to return to normal.
2. Gastric bypass surgery
This surgery modifies the structure of the stomach, and most scholars believe that its mechanism is to control food intake while reducing absorption in the small intestine, in addition to promoting the secretion of hormones such as glucagon-like peptide-1 (GLP-1). The latter stimulates islet secretion and regeneration, making this procedure more effective in improving type 2 diabetes.
What are the results of the procedure?
I would like to introduce you to one of my patients, Mr. Muzi.
Pre-operative case file: height 1.72 m, weight 120 kg. 11 years of abnormal blood glucose, fasting blood glucose up to 20 mmol/L, blood glucose control with insulin and medication. He had a history of hypertension for 4 years and peripheral atherosclerosis for 2 years.
At the first meeting, his desire to improve his quality of life through surgery was extremely strong. Moreover, all of his indicators met the criteria for surgery. After October, Mr. Muzi recovered well and his weight dropped to 84 kg. His fasting and postprandial blood glucose were within the normal range without medication, and his blood pressure returned to normal. The diabetes and hypertension he had suffered from had completely resolved.
When we met again at the follow-up, I, as the surgeon, often felt the huge difference between his image before and after surgery, and if I had not paid attention to the photos he sent me, I might have misunderstood that I had not met him.
Can all diabetic patients be treated by surgery?
In China, the number of diabetic patients and the “diabetic reserve team” is so large, and at the same time, the effect of surgery is so obvious, so is it feasible for them all to undergo surgery?
The answer is no. There are strict indications for the procedure, and it is only suitable for obesity-induced type 2 diabetes. The Chinese Guidelines for the Surgical Treatment of Obesity and Type 2 Diabetes, published in November 2014, have strict requirements regarding patient age, body mass index, islet function, and the choice of surgical approach.
1. Age
Patients with diabetes who are not fully developed or over 65 years of age should not undergo surgery.
2. Body mass index (BMI)
Body mass index (BMI), also called body mass index, is equal to the weight (kg) divided by the square of height (m). It is based on the judgment of this indicator. Normally, what many people call themselves “fat” is not enough for medical “fat”.
Regardless of the type of surgery chosen, the weight will change and the corresponding body mass index will change as well. If the rate of decrease is too rapid, it may cause complications such as malnutrition in patients.
3. Pancreatic islet function
Because the effect of this surgery is dependent on the patient’s islet function. If the pancreas has no “self-care ability” at all, there is no point in surgery.
Why are there so many requirements? Because only by strictly mastering the surgical indications can we get a good outcome for the patient. In the doctor’s eyes, surgery is aimed at improving and enhancing the quality of life. If the evaluation predicts that the patient will not achieve the expected results, such surgery may as well not be done.
Surgery is the best and most helpless option
Most people feel that if they can put on weight naturally, they should be able to lose weight naturally. While this wish is wonderful, there are many studies that show that only about one percent of people who are overly obese successfully lose weight, control their blood sugar, and can stay in shape through their own efforts.
With type 2 diabetes, the pancreas is constantly overloaded, so it is urgent to reduce the functional burden on the pancreas. Surgery is a way to open up a new treatment option for obese patients with diabetes when diet control and conventional medication are hopeless, and it is a welcome relief. However, the patient’s postoperative self-discipline and cooperation are also important factors to maintain the effect of surgery. A sensible and correct lifestyle and diet is the lifelong guarantee of health maintenance.
About weight loss and diabetes surgery
1. Choose the right hospital
The mortality rate of bariatric and diabetic surgery is about 0.2%, which is lower than the mortality rate of cholecystectomy, and the safety of these surgeries can be guaranteed in regular hospitals with mature technology.
2. Consider minimally invasive surgery
Bariatric and diabetic surgery is a benign disease surgery. Under the premise of ensuring the surgical effect and safety, whether the wound is aesthetically pleasing or not also becomes another important requirement and assessment index for patients and operators.
Although a major open surgery can achieve the same therapeutic effect, the deep scars left on the body seriously affect the patient’s psychological and surgical results. Therefore, the pursuit of aesthetic appearance becomes an inevitable requirement for such benign disease surgery. It is imperative to carry out minimally invasive surgery.
Minimally invasive surgery also varies. The traditional five-hole laparoscopic surgery can leave a mark on the scarred patient, and some people tease that their bodies look like “honeycomb coal”. As the technology has matured, reducing the incision of the surgery has also become a major sign of progress in this type of surgery.
Through our team’s tireless efforts, we have reduced the traditional laparoscopic five-hole surgical approach to four-hole, three-hole, two-hole and even single-hole surgeries. The single-port procedure is the choice to enter through the navel, which is the person’s natural scar and appears to have become a true “0” scar in appearance. A patient once jokingly said that the surgical scar is like having a double eyelid done to the navel.
Due to the wide range of surgical instruments, the implementation of single-hole minimally invasive surgery is extremely difficult, so the clinical skills of the operator are very strict, and patients need to be careful when selecting hospitals and doctors.
3. Don’t neglect post-operative recovery
A perfect surgery is only the beginning of the recovery process. In the long years after surgery, a scientific lifestyle and diet are the most important guarantee to eliminate high blood sugar forever.