Diabetes Surgery (Type 2)

Type 2 diabetes is one of the most common diseases suffered by humans. The sufferer and his or her family are those most aware of its seriousness.

This disease, often linked to obesity, has experienced exponential growth in recent years. So much so that the World Health Organization estimates that by 2030, there will be 310 million patients worldwide with diabetes mellitus, the vast majority will be concurrently suffering from obesity.

The social and health costs will be incalculable by any country.

In Spain, the current prevalence of diabetes mellitus type 2 is around 10-15 percent of the population over 18 years old, which is nearly double what it was 15 years ago. With these data, it is estimated that around six million Spaniards between ages 30-65 have type 2 diabetes; about five million of these cases are associated with obesity.

It is generally known that the diabetic patient cannot consume sugar or certain types of food, that insulin levels plummet, and that it is a chronic and serious disease.


Why is it a serious disease?

Diabetes causes injury to the wall of the small blood vessels; it is what is called the diabetic artery, leading to ischemia in all organs and tissues, resulting in permanent injury or death to those organs and tissues. As a result, gangrene occurs in the toes, legs and limbs, requiring amputation in the fingers, feet or limbs.

The kidneys cease to filter urine and stops functioning, which requires dialysis, including kidney transplant.

Diabetes mellitus type 2 produces diabetic retinopathy in the eyes and leads to blindness.

We could go on with a long list of the effects of diabetes that are well known to doctors, but that would only make us depressed.

The great news is:


Is this true? How can you cure a metabolic disease?

In the nearly three decades in which we have been performing surgery to treat obesity, we have indicated that the majority of patients was diabetic, and we verified that diabetes was cured in patients undergoing surgery. We also proved that those surgeries, which prohibited food from passing through the duodenum, next to the pancreas, which is responsible for diabetes, cured diabetes more often than those performed with weight loss as the only objective. This corresponds to the fact that a diabetic who is fasting, who doesn't eat, needs less medication and insulin than when eating.

These observations led us to perform various investigations that support the conclusion that excluding the passage of food through the duodenum blocked multiple hormones that are part of the downward spiral leading to pancreatic failure and diabetes.

Hence gastric bypass became a popular surgery, because by not passing food through the duodenum, successful treatment of diabetes, hypertension, etc. became possible.

This discovery led us to perform an operation in which weight loss was less important, as the patients were not obese, but in which diabetes could be cured by eating normally.


What is this surgery?

It is a surgery that changes the anatomy of the digestive tract, which diverts food away from ​​the pancreas, without affecting metabolic absorption of the distal part of the intestine. It preferentially affects what surgeons call "bile handle." This surgery meets the criteria set out at the beginning of this explanation.

For the reader to understand, we would say that it is similar to bypass surgery. It's what henceforth we shall call Type III Bypass.

Performing this surgery laparoscopically reduces the risk of infection and avoids problems symptomatic of traditional surgeries.


When can this surgery be performed?

The answer is simple, when there still remains a pancreatic reserve (the pancreas are not totally destroyed), in which we test for C-peptide and anti pancreatic and beta cell antibodies through blood analysis.

After attending several medical conferences and meetings on the subject, the first in Rome in 2009 and the most recent in Los Angeles in 2010, we can say that type 2 diabetes can be cured through surgery. By establishing parameters to ensure the best results, they are as follows:

Age: 30-65 years.

• Type 2 diabetes mellitus treated with oral antidiabetic medications.
• Diabetes mellitus type 2, insulin-dependent for less than seven years and difficult to control (HbA1c> 8.0%)
• Has had type 2 diabetes mellitus less than 10 years.
• Diabetic patients whose pancreas has sufficient endocrine reserves (C-peptide ≥ 1 ng/ml).
• Negative anti pancreatic and beta cell antibodies (ICA, IA-2, GAD 65 K).
• Patients with obesity (BMI> 30 kg/m2) associated with type 2 diabetes.

Given that together with diabetes, other diseases such as hypertension, cholesterol, triglycerides etc. can be cured, this type of surgery is called "metabolic surgery," which will be an evolving topic of interest in the coming years.


What is metabolic surgery?

In recent days, especially after the 16th International Conference of Surgery of Obesity and Metabolic Diseases, held in Hamburg, where we were recognized as a Center of Excellence, much has been written by the media about metabolic surgery.


But what is metabolic surgery and what does it consist of?

Metabolic surgery is a type of surgery that is intended to cure or ameliorate metabolic diseases that sooner or later will result in death or disability to those suffering from the diseases.


What are the diseases?

A long list of more or less serious, disabling diseases includes: diabetes, hypertension, high triglycerides and cholesterol, hepatitis or fatty liver etc.

These diseases may or may not be associated with obesity. To occur in non-obese patients and be treated through surgery is why it has been termed metabolic surgery, since it corrects the altered metabolism or mechanism of action (mecanismo de acción) that causes the disease.


What does metabolic surgery consist of?

It is performed on the part or parts of the digestive tract where certain hormones responsible for diseases like diabetes, hypertension, hypercholesterolemia etc. are produced.

Admittedly even today, knowing that they cure diabetes and metabolic diseases, many of the mechanisms of action escape our knowledge.


What results are obtained from this surgery?

Results depend on the metabolic disease being treated, the evolution of the disease, its severity, and the amount and strength of medication needed to control it.

For example, it is easy to understand that a patient will respond better to oral medication than insulin injections to control their diabetes.

But as we pointed out in our blog, recovery rates range from 75 percent at six months after surgery, up to 85 percent at two years, to 97 percent, which we spoke about during the 16th Conference of the IFSO (Hamburg, August 31-September 3, 2011).


Who benefits from metabolic surgery?

Type 2 diabetics, hypertensives, those who suffer from serious hypercholesterolemia, with or without complications (arteriopathy, heart attack etc.).


Who ought to have this surgery and where?

The Centers of Excellence in Bariatric and Metabolic Diseases garner significance for two reasons:

• They guarantee teams that are experts in this disease (surgeons, endocrinologists, etc.)
• The results are controlled by an international committee.

These are assurances for the patient undergoing this type of surgery.

In conclusion, it is recommended that a patient with type 2 diabetes consult a Center of Excellence to know whether his or her diabetes is treatable through surgery.