It is understood that many people with type 2 diabetes are overweight and endocrinologists will advise them to lose weight. Without active weight loss, the pancreas will remain in a state of overload until it “runs out of gas”, at which point the weight loss will simply be a pathology.
Is it true that surgical procedures can also treat diabetes?
In addition to traditional diet control, regular exercise and medication, type 2 diabetes can also be treated through surgery. I believe 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. In 2015, it was again selected as one of the “Top 10 Medical Innovations of the Last Decade”.
The main types of gastric reduction surgery 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 gut, 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.
Sleeve gastric surgery
2. Gastric bypass surgery
This surgery modifies the structure of the stomach, and 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 will stimulate islet secretion and regeneration, thus making this procedure more effective in improving type 2 diabetes.
Gastric bypass surgery
Can all diabetic patients be treated by surgery?
There are strict surgical indications for this procedure, and the Chinese Guidelines for the Surgical Treatment of Obesity and Diabetes, published in November 2014, have strict requirements regarding the patient’s age, body mass index, islet function, and other indications for diabetes surgery.
Indications regarding diabetes surgery include the following.
1. Age
Patients with diabetes whose bodies have not fully developed or who are over 65 years old cannot undergo surgery.
2. Body mass index (BMI)
Body mass index (BMI) (weight divided by height squared) is an indicator used to define “obesity” in medicine, and is also an important reference indicator for diabetic surgery. When BMI is ≥32.5, active surgery is recommended; when BMI is 27.7~32.5, surgery is recommended; and when BMI is 25~27.5, we suggest that surgery should be carried out carefully.
3. Islet function
The duration of type 2 diabetes should not be more than 15 years, and the pancreatic islets should have a certain function of insulin secretion, and the fasting serum C-peptide should not be less than half of the lower limit of normal value. If the pancreas does not have any “self-care ability”, there is no point in surgery.
Why do we need to meet so many requirements to perform diabetes surgery?
Because only by strictly following the surgical indications can we ensure that the patient will receive the best possible treatment. In the eyes of the surgeon, surgery is aimed at improving and enhancing the quality of life, and if the evaluation predicts that the patient will not achieve the desired outcome, such surgery may as well not be done.