Can bariatric surgery cure type 2 diabetes? 
•	Dr. Anis Ansari, Guest Columnist, Feb 13, 2020 
Diabetes continues to spread like an epidemic. There are 150 million people afflicted with diabetes worldwide, with 30 million in the US alone.
In the US, 84 million people are on the verge of being declared diabetic (prediabetic). Diabetes and obesity are very closely related. Almost 90 percent of diabetics are overweight or obese. Obesity (a BMI more than 30kg/m2) is found in 35 percent of women and 31 percent men in our population. An obese person has double the risk of developing diabetes and a morbidly obese person has 10 times the risk as that of a person with a BMI less than 30 kg/m2.
The question is, can bariatric surgery cure diabetes? According to recent study published in the Journal of American Medical Association (JAMA), researchers found that 73 percent of people who underwent a gastric banding and sleeve gastrectomy procedure, achieved normal blood sugar levels within one year.
Yet another study in the Annals of Surgery showed that 83 percent of 240 people who underwent gastric bypass were cured of their diabetes. Likewise, there are many other studies that have proven that bariatric surgery can cure or at least put diabetes into remission.
According to a review of 620 scientific studies involving more than 100,000 patients, researchers have concluded that bariatric surgery, particularly gastric bypass and sleeve gastrectomy cause improvement in blood glucose levels in virtually all cases and a full remission in 80 percent of patients. Strict diabetic control can reduce the risk of heart attack, stroke, kidney failure, blindness, nerve damage and amputation of extremities.
Remission marks a return to normal blood sugar levels without the need for diabetic medications. With glucose at normal levels, the progression of diabetes related complications such as neuropathy, kidney disease and retinopathy, to name a few, is halted, therefore giving the body a chance to repair the damage. Currently the National Institute of Health (NIH) guidelines recommend weight loss surgery for diabetics with BMI above 35kg/m2.
Removing part of the stomach immediately impacts the way blood glucose is processed in the digestive tract. Alteration of the physiology, especially in a gastric bypass, shunts food directly to the distal portion of the intestine, causing increased production of a hormone called glucagon like peptide (GLP–1) which increases insulin production. Also, the rapid loss of weight decreases resistance of the peripheral tissues to insulin, thus decreasing the need for use of insulin or hypoglycemic agents. Bariatric surgery is much more effective than medication alone in management of diabetes.
We are fortunate to have bariatric surgery available right here at MercyOne Clinton. Any obese diabetic patient meeting the above-mentioned BMI criteria, can make an appointment to discuss their options with Dr. Amar Chiruvella, who is fellowship trained and board certified in general and bariatric surgery. He has been performing these bariatric surgeries since 2015, initially at the University of Nebraska Medical Center and now has established a bariatric program over the past few months at MercyOne.
The most common complications of gastric bypass are discussed with patients and include gastrointestinal leak, pulmonary embolism, bowel obstruction and internal hernias. It is estimated that the cost of bariatric surgery works out to be cheaper than just one year of diabetic treatment with insulin or oral hypoglycemic agents.
People who are struggling to decide can always make an appointment to discuss their options. They must commit themselves to lifelong dietary and lifestyle changes. A positive mental attitude and commitment to change for the better can go a long way in achieving the twin goals of weight loss and treating diabetes, which will enable prevention of future complications and lead to a healthy life.
Dr. Anis Ansari is president of the MercyOne Clinton medical staff