Type 2 diabetes isn’t a disease most people think can be treated with surgery, but a growing body of research may change that.

For many patients, bariatric weight loss surgery can be more effective in controlling diabetes than diet, exercise and medication therapies. A large number even enter “diabetes remission” after an operation, meaning their blood glucose levels are close to normal without insulin or other medication. These findings are generally consistent across many studies, including those from the Cleveland Clinic, the Mayo Clinic and the University of Minnesota.

Ninety percent of patients in the United States with Type 2 diabetes are overweight or obese. Losing weight – through diet and exercise or surgery – helps control the disease. But both the weight loss and the glucose control are much more dramatic with surgery, according to a 2013 report from the U.S. Department of Health and Human Services.

A September report in the Annals of Surgery showed that the benefits have lasted up to nine years for some patients. Diabetes did return in others, particularly those who gained a lot of their weight back after surgery, and those who were diabetic for many years before the operation.

Risks are associated with any surgery, and not all diabetics are good candidates. Dr. John Morton, director of bariatric surgery at Stanford Hospital and Clinics, notes that patients receive physical and psychological evaluations and must commit to very strict diet, exercise regimens and many doctors’ visits before and after surgery. He estimates about 30 percent of his bariatric surgery patients are Type 2 diabetics, and the number is growing as more learn about the potential benefits.

“Surgery shouldn’t be seen as a last resort,” he said. “It’s appropriate to talk about with any (Type 2) diabetic who is overweight, on insulin and has trouble controlling blood sugar.”

Here is a look at bariatric surgery by the numbers:

78.1%

The percentage of Type 2 diabetic patients who went into remission for at least a year after bariatric surgery, according to a 2009 American Journal of Medicine report that analyzed results of more than 135,000 patients in 621 bariatric surgery studies.

50%

The percentage of diabetic gastric bypass patients in a separate Annals of Surgery study who were still in remission six years after their operations. Those who chose a gastric bypass over other types of bariatric surgery or who were diagnosed with diabetes less than five years before surgery had the best results.

30-45 pounds

The amount of weight diabetic bariatric surgery patients had lost a year after surgery, compared with about 6 pounds for patients who used diet, exercise and medication for a year to lose weight. That’s according to a Department of Health and Human Services report that focused on patients at the low end of the obesity scale. Surgery patients’ blood glucose levels also dropped about three times more.

35

The American Diabetes Association recommends Type 2 diabetics with a body mass index (BMI) of 35 or greater consider bariatric surgery. Many health insurers cover surgery costs for diabetics in this range. The Health and Human Services report and others have found surgery can benefit patients with BMI as low as 30.

full article here http://www.sfgate.com/health/article/Surgery-effective-for-Type-2-diabetes-4958196.php

Dr McDougall on type 2 diabetes