The effects of a chronically elevated blood sugar are devastating. Diabetes causes early development of blood vessel blockages leading to heart attacks, strokes, kidney failure and loss of limbs of the lower extremity. Diabetics also suffer from early development of cataracts and loss of sensation in the feet and hands. Kidney failure frequently results in a need for dialysis.
Weight-loss surgery is emerging as one of the most effective tools we have to send type 2 diabetes into complete remission.
Childhood onset diabetes is referred to as type 1 and is caused by failure of the body to produce insulin. Type 2 diabetes is referred to as adult onset diabetes and develops when a person develops resistance to insulin produced at normal levels.
About 90 percent of type 2 diabetes is related to obesity. The development of adult type 2 diabetes has been increasing in children in the past decade with significant increases in childhood obesity. In most type 2 diabetics, the development of the diabetes mirrors the increase in body weight.
Patients are initially treated with medicines to increase the body's sensitivity to insulin and frequently progress to needing large doses of insulin. While the extra insulin helps control blood sugar, it also promotes further weight gain which produces further resistance to the insulin.
Even with medical treatment, life expectancy is dramatically decreased in patients with type 2 diabetics. On average, a patient diagnosed with diabetes will have their remaining average life expectancy cut by 30-40 percent. For a 40-year-old, this means dying 11 to 15 years earlier than nondiabetics. A recent report released by United Health Center estimates that by 2050, half of Americans will have either pre-diabetes or type 2 diabetes.
The average annual health care costs in 2009 for a person with known diabetes were about $11,700 compared with about $4,400 for the nondiabetic public, according to a report drawn from 10 million United Healthcare members. The average annual cost nearly doubles to $20,700 with complications related to diabetes.
Because 90 percent of type 2 diabetes is caused by obesity, controlling weight is the key to eliminating diabetes. Once a patient begins taking insulin, weight loss becomes more difficult. The most effective treatment in a patient with obesity is weight-loss surgery. About 85 to 90 percent of gastric bypass patients achieve complete remission of diabetes. Patients undergoing lap band surgery see a 73 percent incidence of complete remission. While diet and exercise are important treatments, these measures alone only achieve a 13 percent incidence of remission.
Gastric bypass cures diabetes by helping patients control their weight as well as producing metabolic changes that improve the interaction of insulin and diabetes. Lap-band patients achieve remission of diabetes through weight control. Gastric bypass patients routinely leave the hospital 48 hours after surgery with their diabetes in complete remission or with their insulin requirements cut in half and the need for insulin quickly eliminated.
With the diabetes in remission, a patient's risk of dying related to diabetes complications returns to that of the nondiabetic patient population. Lifelong diabetes remission is maintained through weight control with routine follow up. While surgery does carry risks, the risks of complications from weight loss surgery are far less than the risk of continuing to remain diabetic and morbidly obese.
Remission of diabetes means adding years to a patient's life expectancy. Remission means a dramatic improvement in quality of life and dramatic decreases in health care cost. The personal cost of eliminating diabetes typically results in thousands of dollars in savings each year.
