Doctors typically consider bariatric surgery for those with a body mass index (BMI) above 40. But a recent study by Cleveland Clinic physicians suggests the threshold can be lower if you have type 2 diabetes.
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It’s a good idea to consider having surgery to help you lose weight if you have diabetes and your BMI is higher than 30, says surgeon Ali Aminian, MD, one of the study’s authors.
Bariatric surgery may help reduce your blood sugar levels over the long term, he says.
Hospitals set the guidelines decades ago when open surgery was the only option for a bariatric procedure. Now that doctors can perform the surgery through small incisions, it’s safer, Dr. Aminian says.
“We have high-quality data in patients with lower BMIs with diabetes that shows it would be a safe and very effective intervention for them,” he says.
What were the study’s findings?
Cleveland Clinic physicians analyzed 252 patients who had surgery at the hospital from 2004 to 2012. Most were overweight or obese, had high HbA1c levels and had diabetes for about a decade. All patients were taking insulin before surgery.
Three-quarters of the patients had gastric bypass surgery. The rest had a sleeve gastrectomy, where the stomach is dramatically reduced in size.
Doctors followed up with the surgical patients five to 12 years later and found:
- 44 percent had long-term glycemic control without insulin.
- 59 percent met the American Diabetes Association glycemic target (HbA1c less than 7 percent).
- 15 percent had achieved remission.
- The patients also lowered their BMI, blood pressure and cholesterol levels.
How does early intervention help?
The beta cells in the pancreas store and release insulin. Over time, as diabetes progresses, the cells burn out and eventually stop working. If you have surgery when you have some beta cells still functioning, results are better, Dr. Aminian says.
Some studies show that those who have bariatric surgery within five years of their diabetes diagnosis have a high remission rate. Doctors see improvement with those who have it later, but it’s not as dramatic, he says.
Long-term remission rates are lower for those who are taking insulin, have higher glucose values and those taking two or more diabetes medications. Because of this, it’s better to intervene when a patient is healthier and the disease hasn’t progressed as far.
“We need to intervene early when patients are healthier and they haven’t reached the stage where they need insulin to control their diabetes rate yet,” Dr. Aminian says. “In patients without these factors, the long-term remission rate is in the range of 80 to 90 percent. Diabetes is not incurable disease.”
However, only about 20 percent of people who try to lose weight or lower blood pressure or glucose levels with lifestyle modifications alone are able to hit their targets long term, he says.
Ready for a long-term commitment?
Most patients tolerate gastric bypass surgery well. But if you aren’t prepared to follow the necessary lifestyle changes over the long term, you wouldn’t be a good candidate, Dr. Aminian says. Also, doctors don’t recommend the treatment for those who have severe psychiatric disorders.
If you think you’re eligible for bariatric surgery — and are ready to commit to it — talk with your doctor or with an endocrinologist about your options.