During recent years, the term “bariatric surgery: a cure for diabetes” has gain strength. Opinions still go both ways and it is no surprise since we are talking about diabetes that,along with obesity, is considered the disease of the century and the number one cause of morbidity and mortality.
In 1995, in North Carolina, Dr. Pories (Pories et al. Ann Surg. 1995) observed for the first time that bariatric surgery reduced blood glucose levels to normal without the need of medication. In his article Who would have thought it? He clearly expressed his surprise of this discovery. Years after, the New England Journal of Medicine published another article, which is clear evidence that gastric bypass is able to remit diabetes (Schauer PH, et al. N Engl J Med. 2012). Recently, numerous institutions have published their experiences showing similar results.
So could diabetes be really cured with surgery? The thing is that “cure” is a really strong word for the complexity of a disease such as this one. Nevertheless, most researchers and clinicians have preferred to use the word “remit” to describe the effect on glucose metabolism after a bariatric procedure.
Patients who already have diabetes complications (partial blindness, diabetic foot, renal insufficiency, etc.), it is possible to reduce the degree of such complications. It is possible for patients with a family history of diabetes to prevent this disease. It also seems that diseases associated with obesity (chronic knee pain, hypertension, sleep apnea, depression, polycystic ovaries, infertility, reflux, etc.) benefit from this procedure. That is why this surgery is now known as metabolic surgery.
Nowadays, prestigious organizations (American Society of Metabolic and Bariatric Surgery, Cleveland Clinic, Colegio Mexicano de Cirugia Bariatrica y Enfermedades Metabolicas, Endocrinologist American Association, etc.) state that the best alternative for obese diabetic patients is metabolic surgery. So, what happens with a diabetic patient who is not obese? Evidence shows that these patients have the same effects on diabetes remission, which suggests that the mechanism by which this procedure remits diabetes is not only based on weight loss but also includes a variety of hormones and substances (GLP-1, leptin, YY peptide, ghrelin, insulin, etc.) produced in the small intestine (foregut hypothesis).
Our patients ask what the best surgery for diabetes remission is; our experience, as well as scientific evidence, shows that gastric bypass and mini-gastric bypass have the highest success rates. With these surgeries, around 95% of patients achieve remission within a few weeks after the procedure. Nevertheless, sleeve gastrectomy has also shown to be a very good alternative for diabetes remission (80%), surpassing gastric bypass by its lower cost and smaller long-term complication rate. At this moment, gastric plication is not considered the best alternative for diabetes remission, however, it can achive an significant glucose control in obese patients with diabetes.