Bariatric Surgery and Type 2 Diabetes Treatment 

An estimated 2 million Australians are currently at high risk of developing type 2 diabetes, the most common form of diabetes. Type 2 diabetes causes blood glucose (sugar) levels to rise higher than normal (hyperglycemia). Having type 2 diabetes means your body does not use insulin properly, unlike type 1 diabetes in which the production of insulin is destroyed by an autoimmune response with no known cure.  

What causes type 2 diabetes?  

We know that most type 2 diabetes instances are caused by obesity – in around 60% of cases the onset or progression can be halted by changes to diet and exercise.  

Diabetes Australia National Position Statement 

Diabetes Australia published a position statement around bariatric surgery and its use in treating obesity or treating and preventing diabetes. Some key points from that statement:  

• Lifestyle interventions that achieve sustained weight loss can prevent or delay the onset of type 2 diabetes and should be the initial approach for all people at high risk. 
• Bariatric surgery is a treatment option for people with type 2 diabetes with a Body Mass Index (BMI) over 35, where lifestyle interventions and medical treatments for obesity or diabetes have not been successful. 
• Weight loss improves blood glucose control through enhanced insulin sensitivity (the action of insulin in the body). Cholesterol and blood pressure also improve. 
• Studies have shown that after bariatric surgery, blood glucose may return to normal without medication in up to three out of four people with type 2 diabetes. Others are able to reduce their diabetes medication. 

Can bariatric surgery reduce cardiovascular disease in those with type 2 diabetes? 

Macrovascular disease is a leading cause of mortality for patients with type 2 diabetes. Macrovascular disease is caused by blockages to large arteries. Large blood vessel blockages lead to heart  attacks, stroke and leg amputations. Unfortunately medical management, including lifestyle changes, may not always be successful at lowering risk.   

An observational study of patients with type 2 diabetes and severe obesity who underwent bariatric surgery, compared to those who did not undergo surgery was conducted. The outcome of the study showed the following:  

• Bariatric surgery was associated with a lower composite incidence of macrovascular events at 5 years (2.1% in the surgical group vs 4.3% in the nonsurgical group) 

• A lower incidence of coronary artery disease (1.6% in the surgical group vs 2.8% in the nonsurgical group) 

• The incidence of cerebrovascular disease was not significantly different between groups at 5 years (0.7% in the surgical group vs 1.7% in the nonsurgical group) 

Overall bariatric surgery was associated with a lower risk of macrovascular outcomes for those living with type 2 diabetes.  

Treatment of type 2 diabetes – medication vs bariatric surgery  

Type 2 diabetes is currently treated by prescribed diabetes medication. Medications for type 2 diabetes are readily available to be prescribed by medical professionals here in Australia as treatment, whereas bariatric surgery is seldom performed in public hospitals, the majority of procedures being performed in private hospitals.  

But doesn’t it make more sense to treat the underlying cause of the diabetes rather than the diabetes itself? For example would you try to treat pneumonia with cough medicine rather than antibiotics? You would expect to see much better outcomes from treating the underlying disease, obesity. The Diabetes Australia position statement even confirms that they believe “Bariatric surgery is a treatment option for people with type 2 diabetes”.