Bariatric Surgery (Stomach Reduction)
A Potential Cure for Persons with Type 2 Diabetes Mellitus
Oct 16, 2009
According to the World Health Organization (WHO), the direct health care cost of diabetes ranges from 2.5% to 15% of annual health care budgets, depending on local diabetes prevalence and sophistication of treatment available. In Canada, the total cost per person which includes hospitalization, day procedures, physician services, prescription drugs and estimated outpatients dialysis service for individuals with diabetes was approximately $4.66 billion in 2000. This figure is projected to increase to $8.14 billion by 2016.
This alarming prospect spurred some Canadian provinces to provide bariatric surgery for obese persons with or without diabetes. The purpose is to "curb" the diabetes epidemic and its attendant health care costs.
Nature and Types of Bariatric Surgery
Bariatric surgery is a surgical procedure involving the reduction of the stomach's size to induce weight loss. There are four types of surgeries. They include:
- Laparoscopic Adjustable Gastric Banding (LAGB). This involves placing an adjustable band around the top part of the stomach, creating a small pouch. This reduction of the stomach leads to an earlier feeling of fullness. It also restricts the flow of food to the rest of the digestive system. The band can be adjusted to further restrict the flow of food, or increase the flow of nutrients which also alters the rate of weight loss. LAGB was approved by the FDA in 2001 as a method to reduce health problems associated with severe obesity. Its advantages are as follows:
- It is less invasive (no cutting of the outside abdominal wall) so it is less painful
- It results in fewer complications such as infections or hernia
- It leads to faster recovery
- Patient can breathe easier and lung function is better with this procedure
- Vertical Banded Gastroplasty. This procedure creates the pouch with both a band and staples.
- Roux-en-Y Gastric Bypass (RGB). This was the most common procedure used in earlier years. First a small stomach pouch is created. This restricts food intake. Then a Y-shaped section of the intestine is attached to the pouch to allow food to bypass the first and second segments of the small intestine. This reduces the body's ability to absorb nutrients and calories.
- Distal Gastric Bypass (Duodenal Bilopancreatic Division). In this procedure, a portion of the stomach is removed. The remaining small pouch is directly connected into the last portion of the small intestine.This procedure has the highest risk for nutritional deficiencies.
Health Benefits of Bariatric Surgery
According to Dr. Rubino of Weill-Cornell Medical College at New York's Presbyterian Hospital, bariatric surgery:
- Improves glucose control
- Lowers blood pressure
- Improves dyslipidemia (abnormal blood cholesterol) in obese and lean patients with type 2 diabetes
- Promotes and maintains weight loss
- Can reduce the incidence of type 2 diabetes by 86% after 2 years, and by 75% after 10 years.
Criteria for Eligibility
Currently some provincial medical plans consider persons with body mass indexes (BMIs) greater than 35kg/m2 to be eligible for bariatric surgery whether they have diabetes or not. However, surgeons and other specialists believe that "lean" persons who developed type 2 diabetes recently (less than 5 years) should also become eligible. They argue that although lifestyle changes can effect health benefits in this population, the chances of them developing diabetes related diseases in the long-term are higher than if they were to undergo bariatric surgery because the procedure can induce diabetes remission.
Who Will Pay for the Procedure
Each provincial Ministry of Health stipulates who is eligible under their respective medical plan. If you are interested in any of these procedures for weight loss, you should contact your Ministry of Health for particulars and your physician to see if you are medically eligible. You should also ensure that your bariatric surgeon is board certified in the province.
Lars Sjostrom of the University of Gothenburg, Sweden, says: "Bariatric surgery is a very favorable option in the treatment of obesity, particularly in obese subjects with prediabetes and diabetes. Lifestyle changes with or without weight-loss drugs have very modest effects on body weight and almost no effect on diabetes resolution."
Sources:
Rubino F et al. "Effect of duodenal-jejunal exclusion in non-obese animal model of type 2 diabetes: a new perspective on an old disease" American Surgery 2004;239:1-14
Czernichow S et al. "Central obesity markers, but not BMI are associated with cardiovascular risk in type 2 diabetic patients:results for the ADVANCE Study" Diabetologia 2009;52:S61
Lee WJ et al. "Effect of laparoscopic minigastric bypass for type 2 diabetes mellitus:comparison of BMI>35 and <35kg/m2" J Gastroenterol Surg 2008;12:945-952
Dixon JB et al. "Adjustable gastric banding with conventional therapy for type 2 diabetes: a randomized controlled trial" Journal of the American Medical Association 2008;299:316-323
Sjostrom L et al. "Lifestyle, diabetes and cardiovascular factors 10 years after bariatric surgery" New England
Journal of Medicine 2004; 351:2683-2693
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