Type 2 diabetes (T2DM) accounts for 95% of all diabetes cases. Obesity is the primary cause of T2DM, and the increase in diabetes prevalence worldwide is directly related to increased rates of obesity. T2DM leads to many health problems, including cardiovascular disease, stroke, blindness, kidney failure, neuropathy, amputations, impotence, depression, cognitive decline, and an increased risk of death from certain types of cancer. Premature death from T2DM increases by up to 80 percent and life expectancy decreases by 12 to 14 years.
Current treatment for T2DM includes lifestyle modification (weight loss, proper diet, exercise) and antidiabetic medication(s). Although medicines and lifestyle changes help the patient recover from the disease, medical supervision and strict adherence to the prescribed diabetes treatment regimen may enable to prevent blood sugar levels from becoming excessively high. T2DM usually worsens over time and requires larger numbers of medicines or higher doses to keep blood sugar under control. Therefore, T2DM is considered a chronic and progressive disease.
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Metabolic Surgery, also known as diabetes surgery, includes operations that control both diabetes and obesity at the same time. Metabolic Surgery is only applied to patients with Type 2 diabetes. Not all Type 2 Diabetes patients are suitable for surgery. The important thing in patient selection is the presence of the insulin-producing capacity of the pancreas. Patients are selected based on this capacity. Diabetes surgery is successfully applied to patients whose capacity is preserved.
Surgical Treatment of Type 2 Diabetes can be applied with various methods that vary according to the patient’s condition.
If the patient is obese and has Type 2 Diabetes due to obesity, obesity surgery is preferred instead of Metabolic Surgery. If the solution of existing metabolic problems is possible by treating diabetes, one of the metabolic surgery operations is selected.
Roux-en-Y Gastric Bypass (RYGB)
Gastric bypass has been practiced for over 50 years. This operation alters the gastrointestinal tract, allowing food to avoid most of the stomach and upper part of the small intestine. The surgery results in significant weight loss, improvement of type 2 diabetes, in about 80 percent of patients. Recovery of diabetes after gastric bypass surgery occurs within days or weeks of surgery or even before excess weight loss. Above all, this surgery causes changes in metabolism and hormones produced in the intestines affecting the body’s ability to reach and maintain a healthy weight.
SLEEVE GASTRECTOMY
It is the process of removing part of the stomach. The remaining stomach is narrow and provides a much smaller chamber for food. The procedure also alters the metabolism and hormones produced by the intestines. These metabolic and hormonal changes result in improvement in type 2 diabetes in more than 60 percent of patients after sleeve gastrectomy surgery.
BILIOPANCREATIC DIVERSION WITH DUODENAL SWITCH
Due to the complexity of the Duodenal Switch procedure and the higher risk of complications, gastric bypass is a malabsorption procedure performed less frequently than sleeve gastrectomy. However, studies show that the operation is most effective in achieving early and sustained treatment of T2DM in 85% of patients.
SINGLE ANASTOMOSIS DUODENO-ILEAL BYPASS+SLEEVE GASTRECTOMY(SADI-S)
SADI-S is the latest procedure approved by the American Society for Metabolic and Bariatric Surgery. This procedure turns the stomach into a tube as in sleeve gastrectomy surgery. The small intestine is cut from the beginning of the duodenum and reattached to an intestinal loop further downstream. The results of this operation are extremely promising, with excellent weight loss and type 2 diabetes recovery.
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