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Weight loss surgery for Type 2 diabetes

For many years, a variety of obesity surgery procedures applied to the stomach or intestine have been used as a method of losing weight, and losing weight can help people manage their Type 2 diabetes.

More recently, medical research has shown that obesity surgery can also directly affect how the body uses insulin. In addition to the benefit of directly losing weight and improving blood sugar levels, this surgery itself assists people in managing their Type 2 diabetes. It can:

  • change how the hormones in your gut work, which in turn affects how your body makes insulin
  • increase the amount of bile acids that your body makes – these make your body cells more sensitive to insulin
  • improve the way the cells use insulin, leading to lower blood sugar levels.

What are the different versions of Type 2 diabetes surgery?

There are various forms of obesity surgery, also known as bariatric surgery, that may be offered. Surgical options include removal of part of the stomach to reduce stomach size and consequently restrict appetite and food intake, or a surgical re-route of the digestive system to bypass the stomach.

Both treatments assist people in reducing their food intake due to requiring less food to feel full, but also beneficially affect how your body uses insulin. You can discuss surgery with your diabetes healthcare team, who will be able to give you further information.

Who can have surgery for diabetes?

Until now, surgery of this type hasn’t been fully recognised as a standard treatment for Type 2 diabetes. NICE obesity guidelines recommend surgery for weight loss for people who meet certain strict criteria, including those newly diagnosed with Type 2 diabetes. However, in practice surgery is mostly offered only for a restricted group of people who have already attempted suitable lifestyle changes and/or received drug treatment for weight loss. Unfortunately, the NICE Type 2 diabetes guidelines also failed to fully recognise surgery as an option for treating Type 2 diabetes.

In May 2016, new international clinical guidelines on surgery for Type 2 diabetes were published by a group of leading international diabetes organisations, including Diabetes UK, and endorsed by 45 international professional organisations. The group states that "obesity surgery, which was originally designed to induce weight loss, should be included among the current treatment options for certain categories people with Type 2 diabetes".

These new guidelines state that surgery should be recommended if they:

  • have a BMI (Body Mass index) of over 40, regardless of how well their Type 2 diabetes is managed, or what other diabetes treatment they are undergoing
  • have a BMI of 35-40 with blood sugar levels that aren’t sufficiently controlled by following a healthy lifestyle and taking medication for Type 2 diabetes.

The new guidelines state that surgery should also be considered if you have Type 2 diabetes, a BMI of 30-35 and your blood sugar levels are not well managed by healthy lifestyle and medication. The guidelines also recommend a lower BMI threshold for those from an Asian background with Type 2 diabetes, as statistically people from that ethnic background can develop Type 2 at a lower BMI to other ethnic groups.

It is important to note that these are guidelines, so it is important to discuss your options with your healthcare team to understand whether surgery is a potential option for you.

Are there any risks of diabetes surgery?

All surgery carries a slight element of risk, but surgery for Type 2 diabetes does not have any greater risk than common surgical procedures. In the long term, there may be a risk of nutritional deficiencies, such as anaemia and the need to take vitamin or nutritional supplements. You will also need regular, long-term follow up consultations and monitoring.

Can surgery cure Type 2 diabetes?

Surgery for Type 2 diabetes is not a permanent cure. However, there is strong evidence that surgery can help some people to stop taking blood sugar medications or place their diabetes into remission. It is important to maintain your regular diabetes reviews so that any relapse in blood sugar levels, or diabetes related complications, can be monitored and treated.

What does Diabetes UK think of the new guidelines?

Evidence shows that surgery is a very effective treatment option for some people with Type 2 diabetes and can be cost-effective for the NHS. Diabetes UK believes that you should have access to all proven effective treatments. Simon O’Neill, Director of Health Intelligence and Professional Liaison at Diabetes UK said: “We strongly support the call for obesity surgery to be fully recognised as an active treatment for Type 2 diabetes alongside established forms of treatment such as following a healthy lifestyle and medications to lower blood glucose levels.”

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