Type 2 diabetes mellitus(T2DM) is the most common form of diabetes. It accounts for approximately 95 percent of all cases. Obesity is directly associated with increased rates of obesity worldwide. T2DM leads to health problems like cardiovascular disease, stroke, blindness, kidney failure, amputations, impotency, cognitive decline and mortality risk from certain forms of cancer. Premature death is increased by 80 percent and life expectancy is reduced by 12 to 14 years from T2DM.

Every 10 seconds a person dies from diabetes somewhere in the world. Diabetes is one of the top ten leading causes of deaths. For a diabetic, health expenditures are 2.3 times higher than a non-diabetic. Approximately 90 percent of type 2 diabetes mellitus is attributable to excessive body fat.
Metabolic and bariatric surgery is the most effective treatment for T2DM among individuals who are affected by obesity

Current therapy for type 2 diabetes includes lifestyle changes (weight-loss, appropriate diet, exercise) and anti-diabetes medication. But T2DM often worsens with time and requires even greater numbers of medication or a higher dosage to keep blood sugar under control. Thus, T2DM has been considered a chronic and progressive disease.

Surgical treatment of Diabetes

Nearly all individuals who have bariatric surgery show improvement in their sugar level and general diabetic state. Bariatric surgeries affect type 2 diabetes in the following ways:
*lowered blood sugar
*reduced dosage and type of medication required
*improved diabetes-related health problems

In some individuals, surgery causes type 2 diabetes to go into remission by:
*reducing blood sugar level to normal range
*almost eliminating the need for diabetes medications
*General health Improvements

Types of Bariatric Surgeries

Roux-en-y Gastric Bypass is a surgery that causes food to bypass most of the stomach and the upper portion of the small intestine. This results in significant weight-loss and causes remission of T2DM in most patients.

Sleeve Gastrectomy (Vertical gastrectomy) removes a large portion of the stomach and, thus, causes weight-loss. Sleeve gastrectomy has some effects on glucose metabolism that favor improvement in diabetes.

The Adjustable Gastric Band involves the placement of a band around the upper portion of the stomach. Remission of diabetes is seen in approximately 45-60 percent of patients.

An electrical device is implanted under the patient's skin. The device controls signals in the nerve which connects the stomach and the brain, reducing the feeling of hunger.
Implanting the device is a minor surgery and it can easily be removed once weight loss is achieved. The device can also be controlled with a remote. However, patients may experience pain, heartburn, problems swallowing, belching, nausea, and chest pain.

Benefits and Risks

While bariatric surgery certainly has some risk, the long-term risk of continued diabetes outweighs the risk of a surgical procedure for most patients. Each patient’s individual risks for surgery as well as their other obesity-related health problems should be evaluated before performing and procedure. Also, the patient must trust only an experienced and highly skilled bariatric surgeon and must follow their doctor's post-op advice.

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