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Updated July 2021 | Written by the Public Education Committee

Obesity and type 2 diabetes (adult-onset diabetes) are closely related conditions, both linked to problems with the body’s metabolism. The same changes that lead to weight loss after surgery can also lead to the remission of type 2 diabetes. Most importantly, patients with this disease should know that the body’s ability to use sugar in a healthy way can be regained with surgery.

Here are a few other facts about type 2 diabetes

  • Diabetes is one of the top 10 leading causes of death in the United States.
  • Living with diabetes puts a person at a higher risk for heart disease, stroke, kidney failure and blindness.
  • About 10 percent of Americans live with type 2 diabetes.
  • Type 2 diabetes is caused by overweight and obesity about 90 percent of the time.
  • One out of every ten dollars spent on health care is spent on diabetes care.
  • Diabetes surgery is the most effective treatment for type 2 diabetes and may result in remission (being able to stop taking all medications) or improvement in nearly all cases.
  • For patients with type 2 diabetes and even milder degrees of obesity, bariatric surgery should be recommended. It is the single most effective way to resolve the condition and stop the need for medication.
  • Diabetes surgery is very safe with complication rates as low as common procedures such as knee replacement and gallbladder surgery

Type 2 diabetes and your health

Type 2 diabetes, the most common form of diabetes, develops when the body becomes resistant to insulin, the hormone that controls the blood sugar levels. There are 32.6 million people in the United States living with type 2 diabetes. Unfortunately, this disease can lead to many serious health problems including heart disease, stroke, high blood pressure, kidney failure, blindness, skin wounds, nerve damage (neuropathy), erectile dysfunction, and cognitive decline among many others. Type 2 diabetes can contribute to premature death or a decreases in the number of years a person is expected to live. Obesity is one of the largest contributors to developing type 2 diabetes.

Initially, treatment of type 2 diabetes may focus on lifestyle changes such as weight-loss, exercise, dietary changes, and anti-diabetic medications. The goal is to stabilize blood sugar levels and prevent further damage to the body through blood sugar control. In many individuals, type 2 diabetes often worsens with time and requires higher doses and more types of medication to keep blood sugar levels under control. Type 2 diabetes tends to be a progressive disease (it gets worse over time) and most people require treatment for the rest of their life.

If you are living with diabetes, you should know that one of the most important discoveries in the management of diabetes is that surgery can help control or improve type 2 diabetes in the large majority of patients.

Surgery to treat type 2 diabetes

Nearly all individuals who have surgery to treat diabetes (also called metabolic/bariatric surgery) show improvement in their diabetes, sometimes as quickly as a few days after surgery. They experience lower blood sugar levels, need less diabetes medications, and see an improvement in diabetes-related health problems. Overall, 78 percent of patients experience remission thus eliminating the need for diabetes medications.

Diabetes surgery performed today has been highly refined over the course of the past 70 years and is among the best studied therapies in modern medicine. These operations result in less food intake and decreased calories absorbed. Most importantly, however, these operations result in changes to the metabolism that affect intestinal hormones that regulate blood sugar control, often before the patient loses any weight. In addition, these procedures reduce hunger, increase the sense of fullness after meals, and assist the body’s ability to achieve a healthy weight. Diabetes surgery has been proven to be the most effective therapy for diabetes but also greatly improves obesity and other associated conditions.

Who is a Candidate for Diabetes Surgery?

A great deal of scientific evidence supports the use of diabetes surgery in patients with BMI of 30 and greater. If you have type 2 diabetes and a BMI of 30 and above, you may qualify for diabetes treatment through surgery. The decision to pursue surgery is made on an individual basis and you can work with your doctors to determine if surgery is a good choice to treat your diabetes.

Want to know more? Read Who is a Candidate for Surgery?

Types of Surgery for Diabetes

The following are the most commonly utilized and approved operations performed in the United States and their known impact on type 2 diabetes. View detailed descriptions of common bariatric surgery procedures.

Roux-en-y Gastric Bypass (gastric bypass):

The gastric bypass has now been performed for over 50 years. This operation alters the gastrointestinal (GI) tract allowing food to avoid (bypass) most of the stomach and the upper portion of the small intestine. The operation results in significant weight loss, remission of type 2 diabetes in nearly 80 percent of patients, and improvement of diabetes in an additional 15 percent.

Improvement of diabetes after gastric bypass surgery occurs within days to weeks after surgery, even before much weight is lost. Most importantly, this surgery results in changes to the metabolism and hormones produced in the intestines that affect the body’s ability to achieve and maintain a healthy weight.

Sleeve Gastrectomy (sleeve):

The sleeve is an operation that removes a portion of the stomach. The remaining stomach is narrow and provides a much smaller reservoir for food. The procedure also changes the metabolism and hormones produced by the intestines. These metabolic and hormonal changes result in an improvement in diabetes. Over 60 percent of patients will have remission of their type 2 diabetes after sleeve gastrectomy.

Biliopancreatic Diversion with Duodenal Switch (duodenal switch):

The Duodenal Switch is a malabsorptive procedure performed far less frequently than the gastric bypass, sleeve gastrectomy or the adjustable gastric band due to the complexity of the procedure and the greater risk of complications. Studies find, however, that the operation is most effective in inducing early and sustained remission or improvement of T2DM (more than 85 percent remission rates with weight-loss independent effects)

Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S):

The SADI-S is the latest procedure to be endorsed by the American Society for Metabolic and Bariatric Surgery. This procedure makes the stomach into a tube just as with the sleeve gastrectomy. The small intestine just below the sleeve is then cut and reconnected to a loop of intestine further down-stream. Results for this operation are extremely promising, demonstrating excellent weight loss and type 2 diabetes remission.

Benefits vs. Risks

Type 2 diabetes remains a leading cause of premature death in the United States and is a major contributor to many significant medical conditions including heart disease, stroke and kidney failure. Each year millions of individuals around the world die from the crippling organ damage that occurs with type 2 diabetes. With the advancements in surgery, many lives can be saved and quality of life can be improved. While diabetes surgery has some risk, these operations have been fine-tuned over the past 70 years and are now among the safest commonly performed operations. The long-term risk of continued diabetes (as well as the risks of obesity) is far greater than the risk of a surgical procedure for most patients. Your surgeon will review the options and work with you to determine if diabetes surgery is right for you. Learn more at EscapeDiabetes.org

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