In a recent study, researchers were able to identify genetic markers that could predict the risk of type 2 diabetes (T2DM). Doctors hope that this will lead to new strategies for predicting and possibly preventing T2DM and other consequences of being overweight. These findings are particularly important, as an estimated 1.5 billion people throughout the world are overweight. Researchers hope their findings could lead to better ways at identifying those most at risk of developing diabetes and help them make changes in their lifestyles to ensure they do not go on to develop this condition.
Here are some things we know:
- Obesity is a major independent risk factor for developing type 2 diabetes, and more than 90% of type 2 diabetics are overweight or obese.
- Modest weight loss, as little as 5% of total body weight, can help to improve type 2 diabetes in patients who are overweight or obese.
- Metabolic and bariatric surgery may result in resolution or improvement of type 2 diabetes independent of weight loss.
Current therapy for T2DM includes lifestyle intervention (weight-loss, appropriate diet, exercise) and anti-diabetes medication(s). Medical supervision and strict adherence to the prescribed diabetes treatment regimen may help to keep blood sugar levels from being excessively high although medications and lifestyle changes cause remission of the disease. In fact, T2DM often worsens with time, requiring even greater numbers of medication or a higher dosage to keep blood sugar under control. For this reason, T2DM has been considered a chronic and progressive disease.
Weight loss surgery may improve blood sugar control by altering levels of gut hormones, as well as by speeding up weight loss. It may also alter the balance of microbes in the digestive system in beneficial ways.
- Studies comparing metabolic and bariatric surgery to nonsurgical treatment for obesity found surgery results in greater weight loss and higher type 2 diabetes remission rates.
- Studies with more than six months follow up showed surgical patients lost an average of 57 more pounds than participants in nonsurgical weight loss programs, and were 22 times more likely to see their type 2 diabetes abate.
- Head-to-head studies comparing bariatric surgery to medical therapy found bariatric surgery superior to medical treatment in producing type 2 diabetes remission, even before weight loss.
- A Cleveland Clinic study showed within one year, diabetes remission rates with bariatric surgery were about 40% (42% gastric bypass, 37% gastric sleeve) compared to about 12% for patients treated with the best pharmacotherapy available; patients had BMI between 27 and 43.
- Catholic University/New York-Presbyterian/Weill Cornell Medical Center showed remission rates were about 85% for bariatric surgery (75% gastric bypass, 95% biliopancreatic diversion) and zero for medical therapy in patients with BMI greater than 35, after two years.
- In surgical groups, both weight loss and preoperative BMI were not predictors of diabetes control, suggesting such surgical procedures may be independent of weight loss.
- 73% of gastric band patients with type 2 diabetes experience remission two years after surgery, a 5 times higher resolution rate than those receiving convention therapy.
- Conventional therapy includes access to general physician, nurse and diabetes educator, and medical therapies including pharmaceutical agents, individual lifestyle modification programs, and physical activity.
The American Diabetes Association recommends bariatric surgery be considered for adults with type 2 diabetes who have a BMI greater than 35, in particular if diabetes or associated comorbidities are difficult to control with lifestyle and pharmacologic therapy. If you live in the Las Vegas area and are considering bariatric surgery, schedule an appointment with Dr. Shawn Tsuda. He and his expert team can help find the right treatment for you.