Diabetes Forecast

Will Weight-Loss Surgery Help?

I have had type 2 diabetes for 15 years and started insulin therapy two years ago. I plan to have bariatric surgery. Is it likely to cause my diabetes to go into remission after I’ve had the disease for so long? Name Withheld

Alison B. Evert, MS, RD, CDE, responds:

As the twin epidemics of obesity and type 2 diabetes continue to worsen, there is increasing interest in bariatric surgery for weight loss and blood glucose control.

WHAT TO KNOW: Since 2005, more than 200,000 bariatric surgery procedures have been performed annually in the United States; worldwide, about half a million are done each year. Despite what is commonly reported in the news, diabetes is not cured by bariatric surgery. However, the surgery may result in the remission of type 2 diabetes (but not type 1) in about 55 to 95 percent of cases. People who have higher A1Cs, use insulin, and have had diabetes longer may have a reduced likelihood of remission.
There are two major classes of bariatric surgery: gastric bypass and adjustable gastric banding procedures. Gastric bypass procedures restructure the digestive system; they include "Roux-en-Y" gastric bypass, biliopancreatic diversion, and biliopancreatic diversion with duodenal switch. Adjustable gastric banding procedures are less invasive. Gastric bypass results in more weight loss and higher rates of diabetes remission than adjustable banding. The Roux-en-Y gastric bypass is by far the most commonly performed procedure.

FIND OUT MORE: You will want to carefully weigh the risks and benefits of weight-loss surgery, including your chances of diabetes remission, with your health care team. While bariatric surgery is at present the most effective therapy to combat severe obesity, it is not without risks, like any surgical procedure.

TAKEAWAYS: Even if you do not have complete remission, bariatric surgery can offer major improvements in glucose control, in addition to weight loss. The long-term benefit of improved glucose control may be the reduction of diabetes complications. Many people who do not experience remission of diabetes following bariatric surgery still may be able to reduce blood glucose medications. Medical and supportive care after surgery is very important to reduce the risk of nutritional deficiencies and weight regain.



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