Curing Diabetes: The Only Confirmed (Pseudo) Cure
Curing diabetes has been a goal of physicians and diabetic patients since it was first discovered by the Ancient Greeks in the 1st century (1).
Almost 2,000 years later, it seems that we have finally learned how to cure diabetes, or at least provide a “pseudo-cure” that puts diabetes into potentially permanent remission: bariatric surgery.
Review and click the sections below to learn more about the only known cure for diabetes.
01Cure Vs. Remission
- Because diabetes can return with weight regain, there is currently no ‘cure’
- Remission occurs when effects of diabetes are completely goned
- Permanent remission is possible with weight loss surgery
Doctors rarely use the term “cure” for a chronic condition like diabetes simply because if something changes in the body down the road, it is often possible for the chronic condition to return.
According to the American Diabetes Association, remission of Type 2 diabetes should be defined as a return to normal measures of glucose metabolism (hemoglobin A1c (average blood sugar level for the past two to three months) below 6%, fasting glucose less than 5.6 mmol/l) at least 1 year after bariatric surgery without hypoglycemic medication.
Different Definitions of Diabetes Remission
The old definition of diabetes remission was being off diabetes medication with normal fasting blood glucose level or HbA1c below 6 per cent.
Many researchers still use this or similar definitions of remission in their study conclusions.
Here’s another way to think about it… diabetes remission means that you are presently “cured” of the condition and will remain so unless the factors causing the disease return to a degree sufficient enough to trigger a relapse (such as weight regain or the return of an unknown underlying “hidden” symptom of the disease).
As long as the bariatric surgery patient remains in remission, they no longer need to take any of their diabetes-related medications and are no longer at risk of developing diabetes-related complications such as blindness, kidney failure, or limb amputation.
- Weight loss surgery results in greater weight loss and much higher chance of remission than non-surgical treatments
Much research has been conducted and published over the last 2 decades about the impact of bariatric surgery on diabetes and other obesity-related health problems.
To best understand and draw conclusions from the stacks of available data, researchers from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Heart, Lung, and Blood Institute (NHLBI) recently convened to collectively review the results.
Following were their key findings:
- Bariatric surgical procedures have resulted in “greater weight loss and type 2 diabetes mellitus remission compared with nonsurgical treatments within the first 2 years of follow-up after bariatric surgery.”
- Long-term studies (greater than 5 years) have shown weight loss, diabetes, and lipid improvements with bariatric surgery.
And following was their published conclusion about curing diabetes with weight loss surgery (2):
“High-quality evidence shows that bariatric surgical procedures result in greater weight loss than nonsurgical treatments and are more effective at inducing initial type 2 diabetes mellitus remission in obese patients. More information is needed about the long-term durability of [control of obesity-related health problems] and complications after bariatric procedures and this evidence will most likely come from carefully designed observational studies.” (text has been bolded for emphasis)
03Official Statements about Bariatric Surgery®
- Most reputable health/governmental organizations recommend/endorse surgery for qualified patients
As a result of the increasing evidence that bariatric surgery may be the most effective treatment for diabetes, several trusted health organizations that specifically focus on curing Type 2 diabetes mellitus or related conditions have released official statements in support of weight loss surgery (click links for the full position statements)…
- Bariatric surgery should be considered for adults with BMI 35 kg/m2 and type 2 diabetes, especially if the diabetes is difficult to control with lifestyle and pharmacologic therapy.
- Patients with type 2 diabetes who have undergone bariatric surgery
need life-long lifestyle support and medical monitoring.
- Although small trials have shown glycemic benefit of bariatric surgery in patients with type 2 diabetes and BMI 30–35 kg/m2, there is currently insufficient evidence to generally recommend surgery in patients with BMI less than 35 kg/m2 outside of a research protocol.
- The long-term benefits, cost effectiveness, and risks of bariatric surgery in individuals with type 2 diabetes should be studied in well-designed randomized controlled trials with optimal medical and lifestyle therapy as the comparator.
Substantial long-term successes of lifestyle modifications and drug therapy have been disappointing in [the obese] population…
…When indicated, surgical intervention leads to significant improvements in decreasing excess weight and comorbidities that can be maintained over time. These include diabetes mellitus, dyslipidemia, liver disease, systemic hypertension, obstructive sleep apnea, and cardiovascular dysfunction. Recent prospective, nonrandomized, observational, or case-control population studies have also shown bariatric surgery to prolong survival in the severely obese.
Different types of bariatric procedures are being performed. Historically, operative mortality was between0.1% and 2.0% with more recent data not exceeding 1%.
Early complications include pulmonary embolus (0.5%), anastomotic leaks (1.0% to 2.5%), and bleeding (1.0%). Late complications include anastomotic stricture, anastomotic ulcers, hernias, band slippage, and behavioral maladaptation.
The number of bariatric operations being performed is increasing tremendously as a result of increasing medical need and the evolution of safer surgical techniques and guidelines. Currently, bariatric surgery should be reserved for patients who have severe obesity in whom efforts at medical therapy have failed and an acceptable operative risk is present.
- In addition to behavioural and medical approaches, various types of surgery on the gastrointestinal tract, originally developed to treat morbid obesity (“bariatric surgery”), constitute powerful options to ameliorate diabetes in severely obese patients, often normalising blood glucose levels, reducing or avoiding the need for medications and providing a potentially cost-effective approach to treating the disease.
- Bariatric surgery is an appropriate treatment for people with type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially when there are other major co-morbidities.
- Surgery should be an accepted option in people who have type 2 diabetes and a BMI of 35 or more
- Surgery should be considered as an alternative treatment option in patients with a BMI between 30 and 35 when diabetes cannot be adequately controlled by optimal medical regimen, especially in the presence of other major cardiovascular disease risk factors.
- In Asian, and some other ethnicities of increased risk, BMI action points may be reduced by 2.5 kg/m2.
- Strategies to prioritise access to surgery may be required to ensure that the procedures are available to those most likely to benefit.
- Available evidence indicates that bariatric surgery for obese patients with type 2 diabetes is cost-effective.
Weight-loss surgery might be an option for people who have extreme obesity (BMI of 40 or more) when other treatments have failed. Weight-loss surgery also is an option for people who have a BMI of 35 or more and life-threatening conditions, such as: Severe sleep apnea (a condition in which you have one or more pauses in breathing or shallow breaths while you sleep) Obesity-related cardiomyopathy (KAR-de-o-mi-OP-ah-thee; diseases of the heart muscle) Severe type 2 diabetes
Bariatric Surgery for Adults
Currently, bariatric surgery may be an option for adults with severe obesity. Body mass index (BMI), a measure of height in relation to weight, is used to define levels of obesity. Clinically severe obesity is a BMI > 40 or a BMI > 35 with a serious health problem linked to obesity. Such health problems could be type 2 diabetes, heart disease, or severe sleep apnea (when breathing stops for short periods during sleep).
Bariatric Surgery for Youth
Rates of obesity among youth are high. Bariatric surgery is sometimes used to treat youth with extreme obesity. Although it is becoming clear that teens can lose weight after bariatric surgery, many questions still exist about the long-term effects on teens’ developing bodies and minds.
04Why Bariatric Surgery Works
- Not fully understood
- Fewer fat cells have less of an impact on body processes
- Bypassing or removing part of stomach impacts hormones and glucose processing
The exact reason that bariatric surgery is so effective at curing diabetes is not fully understood, but it has something to do with:
- The way fat cells affect certain processes in the body. Diabetes is one of many health problems that stem directly from an unhealthy amount of fat cells in the body.
- Bypassing or removing part of the stomach or small intestines immediately impacts the way hormones function and glucose (sugar) is processed in the digestive system (3). This is likely the reason that diabetic weight loss surgery patients often go into remission before losing any weight… even before they are released from the hospital.
While all generally accepted weight loss surgery procedures can result in diabetes remission, some procedures are more likely to do so than others.
Following are the general takeaways from the table of studies found at the bottom of this section…
- Duodenal switch surgery (DS) seems to carry the highest likelihood of Type 2 diabetes remission (most studies indicate a short-term remission rate of over 90% of patients)
- Gastric bypass and gastric sleeve surgery, while not as effective as the DS at curing diabetes, also result in a significant percentage of patients going into remission (anywhere from 50% to over 90% of patients, depending on the study)
- Gastric banding (lap band surgery) appears to be the least likely to lead to diabetes remission (as high as 50% and as low as 7% of gastric banding patient experienced complete remission, depending on the study)
Before deciding on a procedure, there are several other important factors to consider including:
- Expected weight loss & health improvement
- Risk of complications
- Short- and long-term required follow-up care
- Short- and long-term diet requirements
Click the links above or expand the section below for a broader comparison of each type of weight loss surgery.
Study Results Re: Diabetes Curing
There was no significant difference in either Type 2 diabetes (T2D) remission or weight loss with gastric bypass compared with gastric sleeve. Both result in similar early remission of T2D at 3 months (56% to 67% of patients) with modest additional T2D remission with time.
Gastric bypass and gastric sleeve had a similar impact on diabetes remission.
The remission rate at 2 years was 94 % for Type 2 diabetes mellitus.
Diabetes remission had occurred in no patients in the medical-therapy group versus 75% in the gastric-bypass group and 95% in the biliopancreatic-diversion group.
Overall, 68.2 % experienced an initial complete diabetes remission within 5 years after surgery. Among these, 35.1 % redeveloped diabetes within 5 years. The median duration of remission was 8.3 years.
Although we observed some evidence of lower blood pressures and lower fasting serum glucose levels after duodenal switch than after gastric bypass, these differences were not statistically significant.
Remission of T2DM was achieved by 93% in the gastric bypass group and 47% in the sleeve gastrectomy group.
The rate of complete remission of diabetes for the whole study population was 91%.
Median follow-up was 23 months. HbA1c was reduced after operation in all three surgical groups. A total of 34.4% patients had complete remission of diabetes; the remission rates were 40.6 % after gastric bypass, 26% after sleeve gastrectomy and 7% after gastric banding.
One year after surgery, 78% of patients had a remission of their Type 2 diabetes. Patients in the gastric bypass group had a higher diabetes remission rate (91.2) in comparison to patients in the restrictive group (44.8%).
72% of bypass and 17% of banding patients fulfilled the definition of remission at 36 months following surgery.
In comparison to gastric bypass (60% diabetes resolution), duodenal switch (100% diabetes resolution) provides superior resolution of diabetes, hypertension, and dyslipidemia in the super-obese independent of weight loss.
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