18 September 2019
In London, around one in ten people are affected by diabetes. Of this number, around 90% are type 2 diabetes cases, which can be attributed to lifestyle factors. The outlook doesn't look good either, with type 2 expected to affect more and more Londoners, adding to an anticipated UK total of 5 million people by 2025.
You'll already know just how difficult type 2 can be to manage and may have even heard reports of surgery being used to 'cure' it. Here Mr Ahmed Ahmed, Consultant General, Gastrointestinal and Bariatric Surgeon at Bupa Cromwell Hospital, explains whether surgery really can be an effective treatment leading to remission. Mr Ahmed has performed thousands of gastric and weight loss procedures.
Tackling diabetes on various fronts
"Traditionally treatment for type 2 diabetes has been achieved through a combination of lifestyle changes and medication. It's now much easier to achieve normal sugar control through an increasing range of medications and reduction of risk factors, such as weight loss. However, only 10% of patients ever achieve these goals. Any initial weight loss and type 2 remission or improvement achieved with low calorie diets and lifestyle changes is rarely still seen after 1 to 5 years."
Mr Ahmed says that this has led to a search for different solutions and that recently the digestive tract (gut) has become a point of interest in tackling the disease. "Whilst weight loss surgery began with the sole intention of weight loss, the observation of complete or partial remission of type 2 diabetes has led to a new discipline of metabolic surgery."
Metabolic surgery is the term used to describe the various weight loss treatments and procedures used to treat diseases of the metabolism, especially type 2 diabetes. "This type of surgery is effective at improving outcomes in obese patients and in those with obesity related diseases. In particular, with type 2 diabetes, sugar control is achieved rapidly before weight loss - and is sustained."
Weight loss and the 'metabolic effect'
Lots of new scientific evidence suggests that weight loss surgery is better than intense medical therapy for diabetes. This has changed the minds of some doctors, who doubted its benefits before.
"The ability of weight loss surgery to alter metabolism via mechanisms independent of weight loss is certainly a reality, and has been demonstrated for many obesity-related conditions. The mechanisms by which weight loss surgery produces these effects are not understood but include reduced caloric intake, alteration of gut hormones, bile acid circulation and the bacteria in the gut."
So who will benefit most?
The good news is that if you're young, haven't had diabetes for a long time (we're talking decades) and can keep on top of your blood sugar levels then you're much more likely to be 'cured', or at least see a significant improvement. The absence of insulin therapy is also an important factor. The older you get and the longer you've had the disease for are two of the biggest factors decreasing the success rate of surgery.
And where are we now?
Mr Ahmed thinks that doctors should consider weight loss surgery as one of the treatment options for type 2 diabetes, along with lifestyle changes and medical therapy.
"More high quality, long-term follow-up data is also required but for now all evidence points to surgical intervention being much more effective than any existing medical treatment in certain patient groups."
"The gut must be seen as a metabolic organ and has a big role to play in blood sugar control. There is no doubt that further understanding on the precise and important mechanisms is required."
Mr Ahmed Ahmed, Consultant General, GastrointestinaI and Bariatric Surgeon at Bupa Cromwell Hospital
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