When it comes to surgical treatment of diabetes, many patients think of the cutting-edge treatment option – transplantation of islet cells. In fact, in addition to this universally unavailable clinical modality, there is an amazing surgical procedure that can treat some patients with type 2 diabetes – metabolic surgery.
What is metabolic surgery?
First of all, we need to understand that obesity can cause a variety of metabolic diseases (such as: hypertension, hyperlipidemia, diabetes, coronary heart disease, fatty liver, sleep apnea syndrome, hyperuricemia, weight-bearing joint damage, polycystic ovary syndrome and some other metabolic diseases). Because the surgery does not treat type 2 diabetes caused by obesity alone, it is called metabolic surgery.
Metabolic surgery is divided into 2 types.
1. Sleeve gastrectomy.
As in the picture above: removal of the greater curvature of the stomach
Although the surgery looks scary, but we do not have to worry, the surgery can inhibit the secretion of hunger hormone, downward adjustment of human body weight adjustment point, limit solid food intake, adjust the endocrine, change the microflora.
The effect is that the patient will not be hungry, while the rapid weight loss will not cause ketoacidosis, at the same time, does not affect the patient’s absorption. This surgery can effectively treat obesity-induced hyperinsulinemia with type 2 diabetic patients with relatively intact pancreatic islet function.
2. Gastric bypass surgery.
The diagram is shown
The gray part is not over the food, the surgery makes empty over 100cm of small intestine. 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, thus making this surgical procedure more effective in improving type 2 diabetes.
The results of one study found that surgery can result in complete remission in 70% to 80% of type 2 diabetes mellitus cases that meet the indications for surgery.
Complete remission here is strictly defined, which means that no glucose-lowering drugs are needed after surgery, and blood glucose can be controlled by diet and exercise alone, with glycosylated hemoglobin <6.5%, fasting blood glucose <5.6mmol/L, and 2-hour postprandial blood glucose <7.8mmol/L, and needs to be maintained for more than 1 year.
Age: Patients with diabetes who are not fully developed or over 65 years old cannot undergo the procedure.
1.Body mass index (BMI) and islet function: BMI, also called body mass index, is an indicator used to define “obesity” in medicine, and is also an important reference indicator for diabetes surgery.
2. Islet function is relatively intact: Generally, the BMI of this group of people is greater than 32.5. The high body weight only leads to insulin resistance, which makes the blood sugar too high. In this kind of patients, the blood sugar can be normalized by reducing the weight. If these patients need to be treated surgically, sleeve gastrectomy surgery will be chosen.
3. Islet beta cell function greater than 1/2 of normal value: Since the damage to the islets is not very serious, it will lead to weight loss. If the BMI is greater than 27.5 it is possible to control blood sugar through gastric bypass surgery. Some patients can completely relieve diabetes.
4. Islet beta cell function is less than 1/2 of the normal value: Due to the serious damage to the pancreatic islet function, it will lead to a significant weight loss or wasting. Such patients cannot control their blood sugar by their own islet function, so they are recommended to be treated conservatively. Blood sugar is controlled by taking medication or (and) insulin injections.
The results of this procedure need to be supported by the patient’s islet function. If the pancreas has no “self-care ability” at all, there is no point in surgery.
This is because only by strictly controlling the indications for surgery can the patient get a good treatment result. In the eyes of doctors, surgery is aimed at improving and enhancing the quality of life, and if the evaluation predicts that the patient will not achieve the expected results, such surgery may as well not be done.