What is ‘metabolic surgery’ or ‘surgery for diabetes’?
Several procedures used previously with a focus on weight loss have now been established as treatment options for diabetes. Procedures such as sleeve gastrectomy, gastric bypass and duodenal switch are now being increasingly used as therapies for diabetes. These procedures are done using small incisions (laparoscopic or robotic), and are usually
followed by an overnight stay in the hospital.
H
ow can surgical therapies help with diabetes?
It has now been almost a decade since the first randomized controlled trials, the highest quality type of scientific research, showed that surgery can have a profound effect on diabetes. We now know that ‘metabolic surgery’ can lead to significant improvements in diabetes control (a drop in hemoglobin A1c) and need for antiglycemic medications. We also have strong evidence to suggest that surgery decreases the downstream effects of diabetes over the long-run, such as neuropathy, kidney disease and heart disease. Based on the above, ‘metabolic surgery’ for diabetes is endorsed by several scientific societies including the American Diabetes Association and the American Heart Association. When it comes to treatment for diabetes, surgery can completely change the outlook and impact of the disease over time; our patients frequently say that “surgery gave me a new life”, “I no longer have to worry about insulin”, “this has been the best decision of my life”.
How does surgery for diabetes work?
There are several theories about how surgery changes the metabolism of diabetes. Some of these theories focus on changes in the ability of the intestine to process and utilize blood glucose, hence decreasing the negative effects of excess blood glucose on other organs of the body. Alternative theories suggest that surgery can immediately change hormonal signals originating from the intestine that are pro-diabetic. Additionally, with loss of fatty tissue over time, insulin sensitivity can improve, so the human body can utilize glucose better, similar to patients without diabetes.
Who qualifies for these types of procedures?
Surgery for diabetes is usually performed for patients with diabetes and excess weight. For most individuals and insurance plans, this suggests that patients with diabetes and body mass index 35 and over would be potentially eligible for these procedures. Recently published guidelines from medical societies suggest that metabolic surgery can be considered even for patients with lower body mass index, but these guidelines haven’t been adopted by insurance carriers yet. The decision about ‘metabolic surgery’ and the procedure selection is always an individualized one. Any patient can also use the escapediabetes.org calculator to use published data and calculate their own individual benefit from surgery. You can get more information by your own endocrinologist or a provider from our team.
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