New guidelines appearing in the journal Diabetes Care from a group of diabetes experts say that gastric bypass surgery, currently only considered as a way to treat obesity, should also be an option for people with type 2 diabetes, even if they don’t need to lose weight.
That conclusion is supported by the American Diabetes Association and 45 international medical societies, and represents a major shift in the way doctors think about the disease. While diabetes involves imbalances in hormones and metabolism, there’s enough evidence, the doctors say, that bariatric surgery, which involves shrinking the size of the stomach, can not only physically affect how much people eat but also how the body breaks down calories and metabolizes them as well.
The new guidelines suggest that for most people diagnosed with type 2 diabetes, if they don’t respond to existing therapies to control their blood sugar levels, bariatric surgery be discussed as an option for them, even if their BMIs are 30-35; currently doctors only consider the operation for weight loss for people with BMI greater than 35 if they also have other health problems such as high blood pressure or sleep apnea.
What the recommendations don’t provide, however, is a precise formula for when people with diabetes who have BMIs that fall between 30 and 35 should turn to surgery. For now, Francisco Rubino, professor of metabolic and bariatric surgery at King’s College London and one the lead authors of the guidelines, says that “surgery would almost never be a front line intervention for the disease,” meaning that people would have to try current therapies, including insulin and sugar-controlling medications, first. They should also try to adjust their diet and lifestyle as well, and only if those don’t work, then consider surgery.
But having surgery as an option, says Rubino, could go a long way toward helping doctors to rule out treatments that don’t work sooner. Until now, they would simply continue to increase the dose of anti-diabetes drugs since they didn’t have much else to give their patients. But now, they wouldn’t have to keep these people on medications and could consider surgery instead. Doctors will need to monitor people with diabetes who decide to get the operation, and not everyone with diabetes may be a candidate for surgery, but Rubino is convinced that more people with diabetes will be able to control their disease with the new recommendation.