Is There a Cure for Type 2 Diabetes?

I was amazed when I heard the word cure used in the same sentence with Type 2 Diabetes (T2D) by a friend of mine. She’d been in the hospital three times in the last few months with out-of-control blood sugar issues. Always a model patient, insulin and the explicitly followed strict diabetes protocol was no longer working for her. The same surgery I’d had a year ago for the wildly fluctuating weight challenges I’d endured over the past twenty years couldn’t possibly be her cure too.

My friend was searching on the web when she found a June 2016 article, Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes 1. The article stated that countries like Japan and Brazil had been routinely using surgery in the treatment of T2D for some time. It went on to say that with minimally invasive metabolic surgery it might be possible to eliminate all medications and injections, instead of suffering through life with a Band-Aid on her disease.  

The first bariatric surgery was done in 1954 and became more widely used for obesity when laparoscopy or minimally invasive surgery became routine in the 1980s. Metabolic surgery became a more appropriate name for bariatric surgery about ten years ago when medical studies showed the myriad of conditions, diseases, and comorbidities that were helped, reversed, or cured with the simple procedure. The most common include:

  • T2D (even Type 1 Diabetes to a degree),
  • high cholesterol,
  • high blood pressure,
  • depression,
  • cardiovascular disease,
  • migraines,
  • venous stasis (blood clots),
  • stroke,
  • gastric reflux disease,
  • polycystic ovarian syndrome,
  • pregnancy and fertility problems,
  • asthma,
  • sleep apnea, and
  • stress urinary incontinence.

Robert Aragon M.D, The Bariatric Center of Kansas City

Dr. Robert Aragon, one of four highly trained surgeons with The Bariatric Center of Kansas City in Lenexa, Kansas2 says that most patients with T2D can see a marked reduction in the need for insulin within a few days after surgery and may be able to quit their doses completely within a few weeks or months. If the individual suffers from T2D and obesity, this occurs even before the patient has lost significant weight. Of course, one solution is not optimal for every patient.

 

Why surgery works so fast on T2D symptoms

“Most people considering bariatric/metabolic surgery, for whatever reason, initially have a very simplistic view of the process,” says Dr. Aragon. “They believe the surgery, which will either reduce the size of their stomach or bypass it completely depending on the procedure3, will ultimately cause them to eat less and the result will be to lose weight. The reality is that the smaller stomach is the least of the factors that cause the weight loss. The surgery causes a massive metabolic and hormonal change. It’s no different from when a woman has her ovaries removed. Without ovaries, she is likely to have hot flashes, night sweats, mood swings, sleeplessness, fatigue, anxiety, and even loss of sex drive. Our stomachs and intestines are not just reservoirs for food. Like ovaries, they secrete substances that influence our appetite, sense of fullness, the way our bodies manage sugar, store fat, and more. The surgery removes or bypasses the source of these hormones. That is why we see almost immediate results for diabetics, whether weight has been part of the equation or not; their blood sugar comes under control without insulin. … An overweight patient does lose weight, but what’s interesting is that patients who are not obese do not seem to lose weight. They maintain their current weight and just enjoy the metabolic results of the surgery.”

Dr. Aragon also indicated that individuals with Type 1 Diabetes that opt for surgery have much better control of blood sugars. They can reduce the amount of injected insulin, but not eliminate it.

From someone who has had bariatric surgery for weight loss, having the simple procedure done so that I did not have to stick myself with a needle several times a day and have to live with a very restrictive diet seems elementary.

Insurance companies are willing to pay

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In 2015, the 2nd Diabetes Surgery Summit (DSS-II)1 stated as part of their conclusions, “Health care regulators should introduce appropriate reimbursement policies [for individuals suffering from metabolic imbalances].”

Currently, most insurance carriers are more than willing to pay for surgeries for obese patients that meet certain criteria3. “From a financial point of view, bariatric surgery makes overwhelming sense,” says Dr. Aragon. “The money that is saved years down the line by an insurance company is astronomical. We tell patients that on a yearly basis they can save $10,000-$12,000 in prescription drug costs, doctor’s visits, diet programs, and food costs. So for an insurance company to not have to pay for twenty years of diabetic care or other commodities of obesity, it just makes sense. The government is well aware of this, so for individuals that qualify, Medicare doesn’t set up a lot of roadblocks either.”

Dr. Aragon says that if an insurance policy does not cover the surgery, it isn’t the insurance company that is the problem, but the employer that did not negotiate the surgery into their program because rates would be higher. “We’ve had patients band together and change corporate policy,” he says.

So, why hadn’t my friend heard about the surgery before?

“In the 60s, 70s and even 80s before minimally invasive surgery was common there were stories of patients who had bariatric surgery and required weeks in the hospital, had postsurgical problems, did not reach desired outcomes, or developed nutritional deficiencies. This caused most of the stigma and bias that we still see today,” said Dr. Aragon. “Now, with laparoscopic, the surgery takes less than two hours (KC Bariatric does most in less than 45 minutes), there’s minimal downtime, patients lose weight, get off medications, off insulin, become more mobile, and complications are rare.

“In 2005 there were around 140,000 bariatric surgeries in the US. That [number] has grown but at a marginal rate. An impressive or actually unimpressive statistic from the American Society for Bariatric Surgery who sets the standard is that of the patients that would qualify for the surgery based on weight and medical problems, only 2%-3% actually have the surgery. There’s a huge discrepancy between those who need it and those who get it. Even with that today I would say there are over 200,000 surgeries every year in the US. Here at The Bariatric Center of Kansas City, we’ve done about 8000 since we opened in 2002, and around 1600 in 2016 alone.”

Why do I care?

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Twenty-one years ago my husband was diagnosed with a rare form of leukemia. A seemingly perfectly healthy man was given three months to live if he did not undergo chemotherapy; with the chemo, he was told he should go into remission and live at least another four or five years. Doctors wouldn’t predict after that. Like my friend with T2D, he was a model patient and followed their the protocol, but somehow was overdosed on the chemo and lived three months eight days. It wasn’t until his death that I researched alternatives to his treatment. I believe that one of those alternatives would have given us a totally different outcome.

If you have a medical condition and aren’t completely satisfied with the treatment suggested, or the treatment you are undergoing isn’t working, do your research. We are led to believe that we have the finest health care in the world, but numerous countries treat medical conditions successfully in different ways than what is common here in the US. Take charge of your health. My friend is determined to have the metabolic surgery and is working to convince her physician and insurance company that in her case, it is the best solution.

 Sources:

  1. Diabetes Care Volume 39, June 2016 Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations.
  2. The Bariatric Center of Kansas City (http://kcbariatric.com).
  3. Surgical Procedures – Wikipedia – The two most common procedures today are the gastric sleeve, in which the stomach is reduced to about 15% of its original size by surgically removing a large portion and leaving a tube, sleeve, or banana shape. Gastric bypass surgery is where the stomach is divided into a small upper pouch and a much larger lower “remnant” pouch, and then the small intestine is rearranged to connect to both.