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Diabetes, Bariatric Procedures, Risk Factors and Your Options

One of the most frequently asked questions by my patients is “what’s the best operation to cure my type 2 diabetes (T2DM). The simple answer is “it depends on your risk factors.” There are several that I will outline for you.

The first risk factor is how long have you been diabetic? If we lump everyone together, 80% of all diabetics will go into remission with weight loss surgery. If you’ve been diabetic for less than 2 years that number is even higher and goes to 90% achieve remission. In striking contrast, if you have been diabetic more than 10 years, the remission rate drops to 12%. So length of time as a diabetic is a major risk factor. If you are having problems controlling your T2DM, it’s important to think of weight loss surgery sooner rather than later.

Next, the number of diabetes medications also makes a difference. If you are on one oral medication, remission is very likely. However, if you are on more than three medications, the possibility of complete resolution is greatly diminished. Those patients who have had preoperative use of insulin tend to see less resolution of their T2DM as well, as pancreatic production of insulin declines.

Finally, pre-op glycemic control is a risk factor. If your A1C is less that 7%, then you are more likely to respond to weight loss surgery and have your T2DM go into remission.

So, which operation is best for you? By taking into account all of your risk factors, you can get a good idea for what might be the best operation to achieve remission of your T2DM. If your risk factors indicate mild progression of your T2DM then the Roux-en-Y gastric bypass is suggested, but the sleeve gastrectomy has also shown similar response rates. Moderate disease progression best responds to the gastric bypass, while the sleeve gastrectomy has been shown to be much less effective. For patients with advanced progression, or severe and difficult to control diabetes, both procedures offer similar results. Few of these patients achieve remission, although they will see improvement in control.

Throughout this blog, I’ve used the term remission. This means return of normal blood glucose, A1C below 7%, and no longer in need of diabetes medications. If the remissions lasts longer than 5 years, it is considered a cure of your T2DM. While many will see the T2DM return over the first 5 years, they will not see advancement of the complications of diabetes when in remission.

Hope this is helpful information. Weight loss surgery is an excellent choice in not only achieving significant, sustainable weight loss, but also remission of your T2DM as well as reduced complications associated with the progression of the disease. Please don’t hesitate to call us at 303-861-4505 if you have questions. You can also find useful information on our website.

Best,
Dr. Tom Brown
Colorado Bariatric Surgery Institute

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