Myth or fact: I can cure my type 2 diabetes with bariatric surgery?
Over the last year or so, you may have seen increasing reports in the news and on TV talk shows about the effectiveness of bariatric surgery for type 2 diabetes. This revolutionary concept gained considerable attention in 2016 after 45 different medical organizations including the American Diabetes Association and the American Association of Clinical Endocrinologists published a set of guidelines deeming bariatric surgery “a recommended option” for many overweight individuals with type 2 diabetes. When a bunch of doctors get together, there are often as many opinions. So when this many of them can agree on something, it must be special indeed.
What is the real scoop on bariatric surgery for type 2 diabetes? There are numerous medical studies and clinical trials looking at the effect of bariatric surgery on type 2 diabetes, but one of the very best studies published its final data in February of this year from the Cleveland Clinic. This study enrolled 150 overweight volunteers with type 2 diabetes. The volunteers were then randomly assigned to receive medical therapy or to have either sleeve gastrectomy or gastric bypass surgery. The information published this year showed the outcomes five years after surgery. Of those receiving medical therapy, none experienced complete remission of their diabetes at 5 years, according to very strict criteria (hemoglobin A1c less than 6% with no use of diabetes medications). By contrast, the percentages of remission were 22.4% in gastric bypass and 14.9% in sleeve gastrectomy. This study therefore concluded that long-term complete remission of diabetes is a real possibility for bariatric surgery patients, and is far superior to medications and lifestyle changes alone. What these percentages don’t tell you are the even greater number of people who experienced significant improvement in their diabetes with bariatric surgery even if they didn’t meet the extremely stringent definition of diabetes remission used in this study. These are results that cannot be achieved with anything but surgery.
Now, this brings us back to the original question. Can you cure type 2 diabetes with surgery? The answer is more complicated than a yes or no answer. We should consider type 2 diabetes as a long-term, chronic, and life threatening disease much like cancer, or even severe obesity for that matter. Because of this, it is fair to think in terms of remission rather than cure. Greater than 20% of those with type 2 diabetes who have gastric bypass surgery will achieve long-term (over 5 years) remission in their diabetes. More people will achieve short-term remission, and a majority still will experience significant improvement in their diabetes, perhaps eliminating their need for insulin or cutting back on the number of pills they will need. So while it is not accurate to say you will “cure” your diabetes with surgery, it is certainly true that if you are overweight and have poorly controlled type 2 diabetes, surgery just may be the very best thing you can do for your overall health.