As the type 2 diabetes epidemic continues to grow, the most emphasized treatment may surprise you. In the latest update to the Standards of Medical Care in Diabetes, the guidelines put forward by the American Diabetes Association elevate the role of metabolic surgery (also called “bariatric surgery” or “weight-loss surgery”) as a recommended treatment for diabetes.
Experienced centers around the world have achieved complete or substantial remission of Type 2 diabetes in a majority of patients who undergo laparoscopic sleeve surgery, a less-invasive, 45-minute procedure with an overnight hospital stay and four small Band-aids.
The Results Are Remarkable
Metabolic surgeons and centers have known for decades that gastric bypass – and in the past 15 years, gastric sleeve surgery – both deliver remarkable improvement in blood sugar regulation and a high rate of complete reversal of type 2 diabetes.
Better still, individuals with type 2 diabetes enjoy reduced risks of diabetes-related problems including blindness, stroke, heart attack, and kidney failure. Large, high-quality studies have accumulated, demonstrating these results in diabetes improvement across the world.
An early scientific paper, which most notably tipped medical opinion, reported the five-year results from the prospective, randomized STAMPEDE study from the U.S. trial at the Cleveland Clinic.
Patients randomized to either intensive medical management of diabetes or surgery, and the surgery patients fared much better, with many of them still enjoying a healthier life free of diabetes five years after their sleeve procedure. The Swedish Obese Subjects study has shown even better results in 30 years of follow-up.
The ADA and other endocrine society guidelines now acknowledge the proven success of bariatric surgery in treating diabetes. In the published guidelines, bariatric surgery is now referred to as “metabolic surgery.”
As the ADA guideline describes, “A substantial body of evidence has now accumulated, including data from numerous randomized controlled clinical trials, demonstrating that metabolic surgery achieves superior glycemic control and reduction of cardiovascular risk factors in obese patients with type 2 diabetes compared with various lifestyle/medical interventions.”
Here are the latest published ADA recommendations:
BMI 40 or Greater
“Metabolic surgery should be recommended to treat type 2 diabetes in appropriate surgical candidates with BMI 40 kg/m2 (BMI 37.5 kg/m2 in Asian Americans), regardless of the level of glycemic control or complexity of glucose-lowering regimens.”
What this means is that the ADA now states that medical providers should recommend weight-loss surgery to patients with both type 2 diabetes and obesity over a BMI of 40 regardless of other treatments and the patient’s present blood sugar levels.
BMI 35–39
“…and in adults with BMI 35.0–39.9 kg/m2 (32.5–37.4 kg/m2 in Asian Americans) when hyperglycemia is inadequately controlled despite lifestyle and optimal medical therapy.”
This means that for those patients with more moderate levels of obesity, BMI of 35–39, and poorly controlled Type 2 diabetes, providers should now be recommending weight-loss surgery.
BMI 30–34
Finally, the ADA guidelines address the lower level of obesity with type 2 diabetes, those with a BMI of 30–34. In this group, studies have also demonstrated superior results with surgery. The new ADA guidelines state that providers should consider weight-loss surgery when the blood sugar is not well-controlled.
ADA Recommendations
A metabolic surgery should be considered for adults with type 2 diabetes and BMI 30.0–34.9 kg/m2 (27.5–32.4 kg/m2 in Asian Americans) if hyperglycemia is inadequately controlled despite optimal medical control by either oral or injectable medications (including insulin).
The ADA guidelines further comment that “metabolic surgery should be performed in high-volume centers with multidisciplinary teams.” A multidisciplinary team includes professional psychologists, Physician Assistant providers, Registered Dietitians, and a team of multidisciplinary support personnel.
There has in the past been resistance in the medical and dietitian communities to bariatric surgery, but that’s steadily changing.
Many people now feel that these strong evidence-based recommendations from the American Diabetes Association and over 50 international leading endocrinology societies will result in improved treatment of diabetes and improved health for many patients battling diabetes through greater utilization of bariatric surgery.
Have you been affected by obesity or type 2 diabetes? What treatments have you tried? Have you heard of bariatric surgery? Do you know anyone who has undergone this procedure? Would you trust the ADA recommendations if you had these conditions? Please share any questions or comments below.
Disclaimer: This article is not intended to provide medical advice. Please consult with your doctor to get specific medical advice for your situation.
