Enhancing quality of life in diabetics through bariatric surgery

Several years ago, a study analyzed a group of patients and how bariatric surgery improves long term quality of life in type 2 diabetics. STAMPEDE (Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently) trial is the largest randomized trial with the longest follow-up.

The evidence presented found potential benefits of bariatric surgery for patients who have uncontrolled type 2 diabetes. These benefits included an improvement in overall health perception and a reduction in the burden of living with type 2 diabetes. In comparing patients who received diabetic treatment through medications and those who had surgery, the quality of life improvements were much more significant in those who had bariatric surgery. 

Understanding diabetes

Diabetes affects nearly 463 million people worldwide. In America, where the standard American diet focuses heavily on high-carbohydrate foods, diabetes affects about 10% of the population, with 90% of all cases being type 2 diabetes. 

Type 2 diabetes, known as insulin resistance, is when the body’s cells fail to respond to insulin properly. This form of diabetes is often called “non-insulin-dependent diabetes mellitus” (NIDDM) or “adult-onset diabetes.” The cause of this type of diabetes is not fully understood; however, it is most commonly associated with excessive body weight and insufficient exercise.

Obesity and type 2 diabetes

The exact mechanism of how obesity causes type 2 diabetes is still not fully understood. Research suggests that overeating and obesity places stress on a particular cellular organ (organelle) called the endoplasmic reticulum. This organelle is responsible for the processing of nutrients within the cell.

When nutrients are too plentiful, as is the case in many obese patients, the cell sends out signals to the cellular surface to shut down the glucose transport system, inhibiting insulin production on the cell’s surface. Ultimately, this halt of insulin production prevents glucose entry into the cell, leading to persistently higher glucose levels in the blood.

Other medical theories suggest that obesity causes increased levels of fatty acids in the blood, resulting in chronic inflammation. Inflammation might result in a response in the immune cells located in adipose tissue to produce toxic chemicals. Somehow, this inhibits insulin’s action at the cellular insulin receptor level or prevents the pancreas from producing enough insulin. Either way, the result is an elevated blood glucose level.

How bariatric surgery improves long-term quality of life in type 2 diabetics

Given the rising trend in the rate of obesity, the incidence of diabetes is projected to rise as well. Treating diabetes with weight loss surgery is currently the most effective and long-term treatment for obesity and diabetes management. Weight loss surgery procedures are meant for patients to achieve a significant degree of weight loss. Bariatric surgery is a viable solution for diabetic patients, with patients attaining successful weight loss results.  

Based on the results from the STAMPEDE trial, bariatric surgery improves long term quality of life in type 2 diabetics and has a more significant impact on a patient’s long-term quality of life when compared to less intensive medication therapies. Undergoing the gastric sleeve, gastric bypass, or duodenal switch improved physical functioning, general health perception, energy levels, and lifestyle for patients with type 2 diabetes. According to the study, patients treated with medication therapy did not experience the same benefits in improved quality of life as those who had bariatric surgery. 

Regarding social or psychological improvements, the researchers did not find any significant long-term differences between the group treated with medications versus bariatric surgery. 

In general, bariatric surgery improves long term quality of life in type 2 diabetics resulting in improved glycemic control and weight loss. Nearly all bariatric surgery individuals show improvement in their diabetic state within a few months showing statistical results such as:

• Improvement of type 2 diabetes in about 90% of patients
• Type 2 diabetes remission in 78% of individuals
• Improved health and increased longevity last for years, if not a lifetime

This article was originally published on the Bariatric Centers of America blog.