More Evidence for Successfully Reversing T2D

Reversing T2D: recent trials are showing that gastrointestinal surgery may be the new cure for type 2 diabetes, but few patients have access to it.

A newly published study shows that more severe forms of type 2 diabetes are better managed by undergoing gastrointestinal surgery than traditional diabetes medication. In this study of patients in Rome, Italy, approximately 33% of patients who underwent surgery managed to stay free of diabetes for ten years.

This study evaluated 60 patients with diabetes. All of the patients in this study had advanced type 2 diabetes. The experimental group underwent gastrointestinal surgery. The two types of gastrointestinal surgery that these patients with diabetes underwent were biliopancreatic diversion or gastric bypass. The control group was on a diabetes medication regimen as well as lifestyle modification. All of the study participants were classified as being very ill, diagnosed with type 2 diabetes for greater than five years, and with the disease being uncontrolled.

Among the patients that underwent gastrointestinal surgery, 37.5% kept a regular blood sugar without needing any additional diabetes treatment the entire time this study was being conducted. Just as in cancer, the term for this is called remission. According to the American Diabetes Association, for a patient to be cured of type 2 diabetes, they must maintain remission for greater than five years.

The study also showed that patients who underwent gastrointestinal surgery for their type 2 diabetes had a decreased risk of developing comorbidities caused secondary to diabetes. Some of these comorbidities include but are not limited to the following disease states: neurological problems, cardiac issues, and renal problems. In addition, these type 2 diabetes patients also improved their hypertension and high cholesterol, which allowed them to decrease the amount of medication they took before surgery to treat these medical conditions.

With all of the data mentioned above, one might be tempted to opt for gastrointestinal surgery instead of traditional type 2 diabetes treatment and lifestyle modifications. Unfortunately, gastrointestinal surgery, as with most surgeries, does come with its fair share of risks. Patients with type 2 diabetes who elected to undergo biliopancreatic diversion had a greater likelihood of experiencing severe side effects related to the disease state and the surgery than patients on a traditional treatment regimen and lifestyle modification. On the other hand, patients who underwent gastric bypass had a lower risk of adverse events than patients who underwent biliopancreatic diversion and those who utilized a traditional type 2 diabetes regimen along with lifestyle modifications, making this the best treatment option.

The irony in this study is that it looks into the curative effects of gastrointestinal surgery on severe type 2 diabetes patients. Most patients that elect to undergo gastrointestinal surgery do not have severe type 2 diabetes. These patients usually only have a mild form of diabetes or were just recently diagnosed with the disease. One might argue that a new trial needs to be conducted on the effects of gastrointestinal surgery in this particular population since they are typically the ones to get it. With all of that being said, most type 2 diabetes patients will never even get the opportunity to have metabolic surgery. The reasoning behind this is that less than 1% of those eligible for this surgery have access to it worldwide. This issue needs to be improved significantly since it can save lives and improve people’s quality of life.

Practice Pearls:

• More severe forms of type 2 diabetes are better managed through gastrointestinal surgery (which could lead to cure or remission) than traditional medication treatment and lifestyle modifications.
• Gastric bypass is the safer surgery option as it carries fewer type 2 diabetes adverse effects than biliopancreatic diversion and traditional medication treatment.
• Most patients with type 2 diabetes who are candidates for the surgery will never get it as it is only accessible to less than 1% of these people worldwide.

References for “More Evidence for Successfully Reversing T2D”:
Geltrude Mingrone, Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes. The Lancet, Jan 23, 2021

 “Gastrointestinal surgery can be a ‘cure’ for type 2 diabetes finds a new long-term study.” ScienceDaily. ScienceDaily, Jan 21, 2021.

Oluwatayo Ishola, PharmD. Candidate, South College, School of Pharmacy

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