Background
Type 2 Diabetes is a metabolic disorder that results in high circulating blood sugar levels. In the past this type of diabetes was known as ‘non-insulin-dependent’ or ‘adult-onset’ diabetes due to its occurrence mainly in people over 40. Type 2 diabetes is becoming increasingly common and accounts for about 90% of all diabetes cases worldwide.
By 2025, there will be more than five million people with diabetes in the UK.1 According to the International Diabetes Federation (IDF), more than 371 million people across the globe have diabetes and this figure is predicted to rise to over 550 million by 20302.
This increase is largely attributable to increasing levels of obesity coupled with unhealthier diets and lack of exercise. Even individuals who feel healthy, may have a higher than normal blood glucose level (‘pre-diabetes’) and be at risk of getting the condition. It is estimated that there are around 850 million more people in the UK who have diabetes but have not been diagnosed.3
Diabetes Symptoms
Diabetes can cause a variety of symptoms, which may include:
- urinating frequently, particularly at night
- feeling very thirsty
- feeling very tired
- unexplained weight loss and loss of muscle bulk
- itching of the genitals or thrush
- cuts and wounds that heal slowly
- blurred vision
These symptoms are caused by higher than normal circulating blood glucose, with the body trying to get rid of the excess through the kidneys. Without appropriate treatment and lifestyle changes diabetes can lead to a variety of complications including:
Complications of Type 2 Diabetes:
- 2-fold increase in stroke compared to someone without diabetes
- Heart attacks and cardiovascular complications much increased
- Kidney disease
- Diabetes is the leading cause of blindness in people of working age in the UK and leads to increased risk of cataracts.
- Diabetic neuropathy “nerve problems”
- Erectile dysfunction
Type 2 diabetes often requires the use of anti-diabetic medication, or insulin to keep blood sugar levels under control to prevent these complications from occurring. Diabetics often need other medications to help reduce their cholesterol and blood pressure.
It is becoming increasingly clear that if overweight individuals with Type 2 diabetes lose weight through surgery or other means, this can lead to significant improvements in their diabetic control and in some cases a complete reversal of their symptoms, thus minimising their risk of complications.
Recently the National Institute for Health and Care Excellence (NICE) has recommended obese people with type 2 diabetes should be offered weight loss (bariatric) surgery. In particular, NICE advises that those with recent-onset type 2 diabetes who fulfil certain body mass index (BMI) criteria should have surgery.4
Several studies have clearly shown the benefits of bariatric surgery in management of diabetes. A large meta-analysis of 135,000 patients showed that the clinical and laboratory manifestations of Type 2 diabetes resolved or improved in the majority of patients after bariatric surgery.5 Another study looking at remission of type 2 diabetes after gastric bypass has found that type 2 diabetes can be improved and even rapidly put into a state of remission.6
Clearly the approach to diabetes needs to be multi-faceted but is becoming increasingly clear that in the right individuals, bariatric surgery provides rapid and sustainable benefits. – See particularly the page on Bypass surgery and its benefits regarding Diabetes.
References:
1. www.diabetes.org.uk
2. IDF Diabetes Atlas Sixth Edition, International Diabetes Federation 2013
3. http://www.diabetes.org.uk/Documents/Reports/Diabetes-in-the-UK-2012.pdf
4. http://www.nice.org.uk/nice-consults-on-updated-recommendations-for-treating-obesity
5. Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-analysis The American Journal of Medicine: Volume 122, Issue 3, March 2009, Pages 248–256.e5
6. Remission of Type 2 Diabetes after Gastric Bypass and Banding: Mechanisms and 2 Year Outcomes: Annals of surgery Dimitrios J. Pournaras, MRCS, Alan Osborne, MRCS, Simon C. Hawkins, MRCS, Royce P. Vincent, MSc, David Mahon, MD, FRCS, Paul Ewings, PhD, Mohammad A. Ghatei, PhD, Stephen R. Bloom, FRCP, DSc, Richard Welbourn, MD, FRCS, Carel W. le Roux, MRCP, PhD