Diabetes surgery is part of what we call metabolic surgery, which consists of directing surgical techniques towards the modification of certain metabolic processes of the organism in order to improve or cure certain diseases. Thus, by means of some techniques that are already used for bariatric surgery (objective: weight loss) but with small modifications, we achieve that both type 2 diabetes – DM2, as well as other comorbidities of overweight and obese patients (hypertension, dyslipidemia, sleep apnea, hepatic steatosis, etc.) improve and even go into remission.
Patients immediately modify their metabolism after the intervention and are discharged without taking insulin or abandoning oral anti-diabetic medication.
Is it possible to “operate on diabetes” and how does it relate to obesity?
Obesity and type 2 diabetes are closely related, as 90% of patients with DM2 are overweight/obese. This strong relationship has led to the pandemic of both diseases being referred to as diabesity.
Excess fat in the body favors resistance to the action of insulin produced by the pancreas, which has to work excessively and ends up exhausting itself, switching from the use of oral antidiabetic drugs to insulin. Surgery acts by modifying the production of intestinal hormones -incretins- that reduce insulin resistance, which alters the metabolism so that DM 2 goes into remission immediately after the intervention. In addition, metabolic surgery also has a bariatric effect, facilitating weight loss, which helps in the long term to control DM2.
What are the requirements for a patient undergoing diabetes surgery?
The best metabolic results are obtained in patients with less advanced DM2, i.e., those who still have a good pancreatic insulin production reserve. Nevertheless, insulinized patients improve greatly and no longer need insulin injections, although sometimes some oral pharmacological support is required. We consider metabolic surgery for DM2 in patients between 18 and 70 years of age with poor control of their diabetes despite optimized treatment.
What does the surgery itself consist of?
The techniques are similar to some used in bariatric surgery and have passed the test of time in terms of long-term effects, safety, minimal risk and absence of complications. They are performed by minimally invasive surgery, laparoscopic approach, 24h hospital stay, but with general anesthesia. The most frequently used are gastric bypass and vertical gastrectomy.
The bypass consists in the creation of a gastric reservoir with a very reduced capacity that decreases the volume of the intake, and we give the exit directly to the intestine, thus reducing the absorption of some foods, especially fats and certain carbohydrates. Through a double mechanism of exclusion of the transit of food through the duodenum and the shortening of the digestive process, certain incretins are produced and other anti-incretins are not released, whose final effect is the decrease of insulin resistance, correcting DM2.
In the case of vertical gastrectomy we reduce the capacity of the stomach by 70%, so the effect of the shortening of the digestive process and the release of incretins predominates. There are also many other novel surgical techniques that have proven their effectiveness, but many of them have not yet passed the test of time and are still in the experimental phase.
What will the postoperative period and results be like?
The postoperative period is very quick, the surgery causes hardly any pain and recovery is very fast. In this way, the patient is able to leave the hospital 24 hours after the intervention and return to work a week after the procedure.
The results are spectacular, since the patient leaves the hospital without the need for insulin and with excellent control of blood sugar levels.
Will the patient have to follow any special diet?
The first week of the postoperative period the diet is exclusively liquid, so that the intestinal sutures heal correctly. We will progressively change the textures, qualities and quantities of food in the following weeks so that, approximately one month after the intervention, you can eat practically everything (in quality, not quantity).
Of course, it is essential to have a multidisciplinary team with dietician-nutritionist, psychological and endocrinological support, to achieve the most effective in the long term to maintain health: the change of habits.