Weight-loss surgery is a proven way to quickly and effectively improve the control of blood glucose levels for patients with Type 2 diabetes.
Until recently, however, the surgery hadn’t been formally included in the clinical practice guidelines that doctors follow in treating Type 2 diabetes patients.
That changed this year, when the world’s leading diabetes groups—including the American Diabetes Association—issued a joint statement recommending weight-loss surgery for some patients with diabetes. This includes those who are mildly obese and have failed to respond to conventional treatment.
According to the new guidelines, doctors should recommend bariatric surgery to treat Type 2 diabetes in patients with:
- Body mass index, or BMI, of 40 or more.
- BMI between 35 and 39, if blood glucose level is not controlled by lifestyle and medical therapy.
It should also be considered in patients whose BMI is between 30 and 34.9 if their blood glucose level is not controlled, the statement said.
The statement comes after a decade of investigation by these groups, according to Jon Schram, MD, a Spectrum Health Medical Group physician who specializes in bariatric surgery and weight management. It also comes after other countries in Europe and South America had already been following this approach.
In the United States, the National Institutes of Health guidelines call for bariatric surgery for those with a BMI of 40 or more, or those with a BMI of 35 or more with a serious health problem linked to obesity, such as Type 2 diabetes, heart disease or sleep apnea.
The National Institutes of Health guidelines determine if insurance companies will cover the procedure for particular patients, Dr. Schram explained.
“We are seeing change now because of the profound effect bariatric surgery can have on Type 2 diabetes,” he said. “If we can do it with people who have a BMI of 35, why not with people whose BMI is 34, 33, 32, 31 or 30? We know that diabetes is extremely difficult to treat and has lifelong associations with other diseases.”
Dr. Schram pointed to recent studies that show weight-loss surgery patients lose more weight and achieve significant and longer-lasting reductions in their blood sugar levels as compared to those who underwent conventional medical therapy.
Gregory J. Deines, DO, a Spectrum Health Medical Group internal medicine physician specializing in endocrinology and metabolism, also said weight loss is critical for obese patients with Type 2 diabetes—and gastric surgery is a way to achieve this quickly and effectively.
But surgery might not be the choice of all patients, he said.
“Our challenge is to help people who don’t want to have surgery still achieve significant weight loss,” Dr. Deines said.
Patients may choose to forego surgery for a variety of reasons, Dr. Deines said. Some don’t want to deal with the side effects of major surgery, and some may not want to make the lifestyle and nutritional changes that come with altering their digestive tract.
He works with patients to find the right weight-loss therapy for them, whether it be medication, diet and nutrition, surgery, or a combination of all three.
“We certainly would not want somebody to have an elective surgery that they don’t want to have,” Dr. Deines said. “We need to find what’s going to work with them for their lifestyle.”
Dr. Deines said his team works closely with Dr. Schram and his team, creating a coordinated effort for patients who do opt for surgery.
“One of the benefits of what we’re able to do here at Spectrum Health is coordinate the medical and surgical options for weight loss all within one system,” he said. “If we send someone to Dr. Schram and his team, they see everything we have talked about in our program, and it coordinates with their program.”
About 29 million Americans have diabetes, or about 9 percent of the population, according to the most recent data from the American Diabetes Association.