Advanced Diabetes Surgery: New Hope for Patients

Diabetes is a chronic condition that affects millions of people worldwide. It is a major cause of various health complications, including heart disease, stroke, kidney failure, and blindness. With the increasing prevalence of diabetes, particularly type 2 diabetes, there is a growing need for effective treatments. One promising approach is advanced diabetes surgery, which offers new hope for patients struggling to manage their condition.

This article explores the relationship between diabetes and obesity, the effectiveness of diabetes surgery, and the various surgical options available.

Understanding the Relationship Between Diabetes and Obesity

Obesity and type 2 diabetes are closely related conditions, both linked to problems with the body’s metabolism. Type 2 diabetes, also known as adult-onset diabetes, develops when the body becomes resistant to insulin, the hormone that controls blood sugar levels. Approximately 90 percent of type 2 diabetes cases are caused by overweight and obesity. This strong connection between obesity and diabetes highlights the importance of addressing both conditions simultaneously.

The Impact of Diabetes on Health

Diabetes is one of the top 10 leading causes of death in the United States. Living with diabetes puts a person at a higher risk for heart disease, stroke, kidney failure, and blindness. Additionally, diabetes can contribute to premature death or a decrease in the number of years a person is expected to live. The financial burden of diabetes is also significant, with one out of every ten dollars spent on health care being allocated to diabetes care.

The Promise of Diabetes Surgery

Diabetes surgery, also known as metabolic or bariatric surgery, is the most effective treatment for type 2 diabetes and may result in remission or improvement in nearly all cases. This type of surgery can help patients regain the body’s ability to use sugar healthily. For patients with type 2 diabetes and even milder degrees of obesity, bariatric surgery should be recommended as it is the single most effective way to resolve the condition and stop the need for medication.

Diabetes surgery is very safe, with complication rates as low as common procedures such as knee replacement and gallbladder surgery. The surgery has been highly refined over the past 70 years and is among the best-studied therapies in modern medicine. Nearly all individuals who undergo diabetes surgery show improvement in their diabetes, sometimes as quickly as a few days after surgery. Scientific evidence supports the use of diabetes surgery in patients with a BMI of 30 and greater.

Types of Diabetes Surgery

There are several types of diabetes surgery, each with its own benefits and success rates. The most commonly utilized and approved operations performed in the United States include:

1. Roux-en-Y Gastric Bypass

This surgical option promotes weight loss and remission of type 2 diabetes for almost 80 percent of patients. It involves creating a small pouch from the stomach and connecting it directly to the small intestine, bypassing a large part of the stomach and the first part of the small intestine.

2. Sleeve Gastrectomy

Over 60 percent of patients will have remission of type 2 diabetes after this procedure. It involves removing a large portion of the stomach, leaving a tube-like structure, which reduces the amount of food that can be consumed and decreases hunger.

3. Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S)

This procedure has demonstrated excellent rates of weight loss and type 2 diabetes remission. It combines a sleeve gastrectomy with a bypass of a significant portion of the small intestine, which helps in reducing calorie absorption.

Long-Term Benefits of Diabetes Surgery

Bariatric weight-loss surgery provides more long-term benefits for managing type 2 diabetes than lifestyle changes. Participants who had the surgery consistently had lower HbA1c levels, indicating better blood sugar control, at every follow-up point, despite starting the study with higher baseline levels. At the seven-year follow-up, 18% of participants achieved diabetes remission, compared to 6% in the medical and lifestyle groups. At the 12-year follow-up, participants who had surgery achieved an average of 19% weight loss, compared to slightly less than 11% in the medical and lifestyle intervention group.

Cardiovascular Benefits

Metabolic surgery offers significant cardiovascular benefits for patients with diabetes. Patients with diabetes and a history of metabolic surgery had significantly fewer heart attacks, strokes, hospitalizations, and deaths compared to matched patients who did not have the surgery. Patients reduced their chances of winding up in a hospital with a heart attack by more than 35%, a stroke by more than 25%, and congestive heart failure by nearly 15%.

• Reduced risk of cardiovascular disease: Studies show that people who underwent diabetes remission had a 40-49% lower risk of developing cardiovascular disease.
• Lower risk of heart disease: Remission from type 2 diabetes can reduce the risk of developing heart disease.
• Reduced kidney disease: Diabetes remission can lower the risk of developing kidney disease by 33-55%.
• Lower cholesterol levels: Weight-loss surgery can lower LDL (bad) cholesterol in the lifestyle intervention arm of the trial.
• Blood pressure reduction: Managing blood pressure can reduce the risk of diabetes-related complications.

Challenges and Considerations

While diabetes surgery has some risks, these operations have been fine-tuned over the past 70 years and are now among the safest commonly performed operations. However, there are some challenges and considerations to keep in mind. Anemia, fractures, and adverse gastrointestinal symptoms were more common in those who received bariatric surgery. The decision for bariatric surgery is often up to the health insurance company, and many times, individuals with a BMI of under 35 do not get approved for the surgery.

Risks and Complications

While diabetes surgery has some risks, these operations have been fine-tuned over the past 70 years and are now among the safest commonly performed operations. The complication rates are as low as those for common procedures such as knee replacement and gallbladder surgery.

Recent Advances in Diabetes Treatment

In addition to diabetes surgery, there have been several advancements in diabetes treatment and management in recent years. New medications, high-tech insulin pumps, and new legislation capping the cost of insulin for people on Medicare will become available in 2023. The FDA has also approved the first cellular therapy to treat patients with type 1 diabetes in 2023, Lantidra. Continuous glucose monitoring (CGM) is increasingly being used in people with type 2 diabetes.

One of the biggest hits in type 2 diabetes treatment are glucagon-like peptide (GLP)-1 receptor agonists, which induce insulin production in beta-pancreatic cells while suppressing the secretion of glucagon, a hormone with the opposite effect to insulin. An innovative development is the creation of combination therapies like Tirzepatide, which intertwines the sequences of GLP-1 and gastric inhibitory polypeptide (GIP) in a single molecule, functioning as a co-agonist.

New Therapies for Type 1 Diabetes

1. Cellular Therapy

The FDA has approved a new cellular therapy for Type 1 diabetes called Lantidra. This therapy uses cells taken from human organ donor pancreases and is administered by infusion into the body’s portal vein. Studies have shown that some participants did not need to administer insulin for more than five years after receiving Lantidra.

2. Stem Cell Therapy

Promising early results from Harvard Stem Cell Institute research have paved the way for a breakthrough treatment of Type 1 diabetes. Vertex Pharmaceuticals has developed VX-880, an investigational stem cell-derived, fully differentiated pancreatic islet cell replacement therapy. This innovative therapy gives patients functional hormone-producing cells that control glucose metabolism .

3. Teplizumab (Tzield)

Advancements in diabetes surgery and technology are providing new hope for patients. From bariatric surgery to continuous glucose monitoring and innovative therapies for Type 1 diabetes, these developments are transforming the lives of those affected by this chronic condition. As research continues and new treatments become available, the future looks promising for diabetes patients seeking better outcomes and improved quality of life.

Conclusion

Advanced diabetes surgery offers new hope for patients struggling to manage their condition. With its proven effectiveness in achieving diabetes remission and improving overall health, diabetes surgery is a promising option for many patients. As research continues to advance, the future of diabetes treatment looks brighter than ever. By addressing both diabetes and obesity, patients can achieve better health outcomes and enjoy a higher quality of life.