Metabolic Surgery for Diabetes
Type 2 diabetes is one of the most rapidly emerging health crises of our time. For many years, people with Type 2 diabetes used medication and lifestyle changes to control this chronic disease. New research suggests that the use of metabolic surgery, also known as bariatric surgery, can be used to treat Type 2 diabetes. Evidence has shown that it may result in better control of blood sugar, and even complete remission of the disease.
The ability of the gastric bypass operation to improve or cure Type 2 diabetes has been recognized for many years. In the early 1990s, it was found that over 80 percent of obese Type 2 diabetics maintained normal blood glucose levels after their surgery. Research has shown the control of blood sugar was not dependent upon weight loss. Rather, the improvement occurred within several days of the operation, before any significant weight loss occurred. This finding suggested that the "rerouting" of the gastrointestinal tract that occurs in gastric bypass was directly responsible for these results.
New Findings in Metabolic Surgery
Metabolic surgery took a tremendous leap forward in April 2012, when two landmark trials were published in the New England Journal of Medicine. Metabolic surgery was directly compared to traditional medical therapy for Type 2 diabetes. In the first study, 60 patients with Type 2 diabetes were randomly divided into two groups. The first group underwent gastric bypass as a metabolic procedure, while the second group received conventional medical therapy, but no surgery. Seventy-five percent of the surgical patients experienced complete remission of their diabetes, while none of the medically-treated patients did. In the second study, patients assigned randomly to medical therapy alone, or surgical and medical therapy together, were compared. More than three times as many patients in the surgery group enjoyed full control of their diabetes in comparison to the medical group.
Interdisciplinary Treatment for Diabetes
Despite the research, in the United States, health insurance will only pay for surgery when the primary purpose is weight loss. To see if you are eligible for this surgery under nationally recognized guidelines, consult your surgeon. At Mount Sinai, we have created a comprehensive, interdisciplinary program that is staffed by surgeons, endocrinologists, dieticians and other pertinent specialists. We regularly treat patients with metabolic diseases, including Type 2 diabetes. Working closely with the Mount Sinai Diabetes Center, obese patients with Type 2 diabetes undergo a thorough evaluation to determine the best treatment. Our team of specialists will personalize the treatment recommendations based on the patient's clinical situation.
The surgeons of the Division of Metabolic, Endocrine and Minimally Invasive Surgery are continually evaluating methods of using surgery to treat Type 2 diabetes. We perform minimally invasive operations, including laparoscopic gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic adjustable gastric banding on a daily basis. While these operations are only being performed on obese patients, our goal is eventually to also treat diabetic patients in lower weight categories. With new data emerging constantly at the Division of MEMIS at Mount Sinai, in the near future it is entirely possible that Type 2 diabetes will go from a disease that can only be controlled with medicine, to a disease that will always be cured with surgery.