The United Nations Diabetes Day is celebrated every year on November 14. When it comes to diabetes treatment, the first thing that comes to mind is diet control, exercise, glucose-lowering drugs and insulin. In 2011, the International Diabetes Federation (IDF) issued a statement recognizing bariatric surgery as an appropriate treatment for obese patients with type 2 diabetes who have poor glycemic control. And many hospitals in China have also carried out diabetes surgery, which makes many sugar lovers full of expectations, but whether surgery for diabetes is suitable for all diabetes patients, and whether it can completely cure diabetes? The majority of type 2 diabetes patients are particularly concerned.
I. How does surgery treat diabetes?
The term “diabetes surgery” actually refers to surgery that can improve the metabolic function of the body. In the 1980s, some doctors found that obese patients who underwent bariatric surgery lost significant weight while their blood sugar levels were well controlled.
The efficacy of diabetic surgery is based on 3 main principles: First, it shrinks the stomach, reduces energy intake and absorption, uses the excess energy reserves in the body, and maintains internal balance. Secondly, it reduces weight. After surgery, most patients can lose about 30% of their body weight, and the insulin resistance caused by obesity will be reduced, and blood sugar will gradually return to normal. Third, after gastrointestinal reconstruction, it can play the role of regulating the intestinal secretion of insulin level, so that the level of pancreatic secretion can be improved, and blood sugar will be gradually normalized.
Why do we need to operate “knife” for diabetes treatment?
When it comes to diabetes treatment, we will first think of diet control, exercise, hypoglycemic drugs and insulin. However, it is difficult to maintain the long-term stability of blood glucose with all the medical treatment methods, and cannot avoid the emergence and further aggravation of various complications of diabetes.
Appetite control, which requires strong willpower, is difficult for patients with severe obesity; and for this group of people, exercise puts tremendous pressure on their joints, lungs, and heart, with high health risks. Strict dietary control and repeated blood sugar fluctuations cause constant mental stress to patients and affect quality of life. Some patients with severe obesity, their blood sugar is always poorly controlled even though they have played a large dose of insulin or have used three or four kinds of drugs in combination with glucose-lowering treatment.
Third, who is suitable for surgical treatment?
In March 2011, the International Diabetes Federation issued a statement endorsing bariatric surgery as one of the measures for the treatment of type 2 diabetes and recommending that patients who are eligible for surgery should consider undergoing it as early as possible. However, special attention should be paid to the fact that diabetes surgery is only suitable for some patients.
In the same year, the Chinese Medical Association Diabetes Branch and the Chinese Medical Association Surgery Branch jointly issued the Expert Consensus on Surgery for Diabetes (hereinafter referred to as the Consensus), which clarified the indications for surgery suitable for Chinese patients, mainly including.
1. Patients with type 2 diabetes whose body mass index (BMI in kg/m2, i.e. weight (kg) divided by the square of height (m)) is >35;
2.Patients with BMI of 30~35, who have difficulty in controlling blood glucose or complications with lifestyle and medication, especially those with high risk factors for cardiovascular disease;
3, BMI of 28~29.9 with centripetal obesity (waist circumference >85 cm for women and more than 90 cm for men) and at least two criteria for metabolic syndrome (high triglycerides, low HDL cholesterol level, high blood pressure);
4, BMI 40 or BMI 35 but with severe comorbidities, and adolescents aged >15 years with mature skeletal development;
5. Patients under 60 years of age, in good health and with low surgical risk.
IV. What conditions are contraindications to surgery?
Contraindications to surgery as stated in the Consensus include: patients with drug abuse, alcohol addiction, or mental illness; patients with a clear diagnosis of type 1 diabetes; patients with type 2 diabetes whose islet function has been largely lost; patients with combined bleeding disorders or coagulation abnormalities, or those whose cardiopulmonary function cannot tolerate surgery; patients with a BMI of 28 and whose blood glucose can be satisfactorily controlled with medication or insulin therapy; patients with gestational diabetes and other special types of diabetes. Patients with gestational diabetes mellitus and other special types of diabetes mellitus.
V. What is the risk of surgery?
Take the “gold standard” surgery of gastric bypass as an example, it takes about 2 hours to complete the surgery laparoscopically, and the patient is discharged from the hospital 3-5 days after the surgery, and the cost of the patient is 40,000-60,000 RMB. Although the complications of laparoscopic surgery are relatively minor, surgical complications are still an important factor to consider for patients with diabetes. However, major long term complications include malnutrition, iron deficiency anemia, folic acid deficiency, vitamin B12 deficiency, and intractable diarrhea.
The long-term effects of the procedure are still being evaluated in academia, and the results vary widely from patient to patient. Therefore, the indications must be strictly grasped and the procedure must be carefully slowed down.
VI. What are the results of diabetes surgery?
So, how good are the results of diabetes surgery? For this result, there is no uniform conclusion at home and abroad. However, surgery does not benefit all diabetic patients, and the available evidence is not enough to prove that surgery can completely cure diabetes. So it is still important to treat diabetes aggressively as well as make lifestyle changes after surgery.