Health Column: Surgery that ‘cures’ your type 2 diabetes
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist
Thirty years ago, Gloria (not her real name) — a perfectly rotund, diabetic patient of mine — ventured to Baltimore for an operation. She returned to Grand Junction with a scar on her belly and hope in her heart that her extra pounds would melt away and that her diabetes would get better. One year later, after three hospitalizations for wound infections and a bleed from her stomach, Gloria was back to her previous 305 pounds and her diabetes was still poorly controlled.
WHAT IS BARIATRIC SURGERY?
Bariatric operations are of two types. Restrictive surgery (like lap band) limits the stomach’s size, decreasing the volume it will hold from three pints to two tablespoons. Malabsorptive procedures limit the calories that can be absorbed into the body. Some bariatric operations combine both types of procedures. In general the operations that employ malabsorptive techniques are more effective in fostering weight loss, but are also associated with more complications.
Fast forward three decades. Today the outlook for bariatric surgery for obese type 2 diabetics is much more optimistic.
As surgeons have gained more experience and surgical techniques have improved, complication rates have fallen. The infections from leaks and bleeding complications that Gloria experienced are less common today.
Current guidelines for bariatric surgery require extensive physical, nutritional and psychological preoperative evaluations. Potential candidates must understand the need to follow a fairly rigorous diet and follow up with their bariatric surgeon forever.
Recent studies show that bariatric surgery actually works for type 2 diabetics in the long run. The Swedish Obesity Study (SOS) followed a group of 4,047 type 2 diabetics who underwent either bariatric surgery or intensive medical treatment. After 15 years, 30 percent of those who had bariatric surgery were “free” of diabetes, while only 7 percent of the group treated with medicines were “cured.”
Just exactly what “cured” of diabetes means is not clear. The SOS revealed that the bariatric operations cut the risk for eye and kidney complications in half, but only modestly decreased the patients’ risk of heart attacks.
My take: Although the pharmaceutical industry has graced us with a host of new diabetes drugs, cardiovascular complications continue to shorten life spans of middle-aged diabetics by eight years on average. My skepticism (induced by Gloria and others) for bariatric surgery has softened. I now see these operations as potential treatments for a small group of very motivated type 2 diabetics. Both Community and St. Mary’s hospitals have active bariatric programs. Are you a candidate for bariatric surgery? Talk to your primary care physician.
Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for Rocky Mountain Health Plans. Email him at email@example.com.
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