If you or a loved one is working through the challenges of type 2 diabetes, you know just how important proper management is to preventing severe health problems. With millions affected by this condition, finding the best treatment approach is as important as ever.
Traditionally, medical management—consisting of lifestyle changes and medications—has been the standard practice of diabetes care.
But in recent years, bariatric surgery has emerged as a real game changer, often leading to better glycemic control and higher rates of diabetes remission.
Long-term studies reveal that patients who undergo bariatric surgery often need fewer diabetes medications and experience significant weight loss. Sounds promising, right?
But how does this surgical approach compare to the traditional methods of medical management?
Let’s explore both routes to see which treatment method is the better option for long-term, type 2 diabetes management and overall quality of life.
What is Type 2 Diabetes?
Type 2 diabetes is a chronic condition where the body can’t regulate and use glucose properly, resulting in high blood sugar levels. This happens because the body either becomes resistant to insulin—the hormone that allows cells to absorb glucose from the bloodstream—or doesn’t produce enough insulin to maintain normal glucose levels.
In rare cases, someone can be both insulin-resistant and insulin-deficient.
When glucose levels remain high over time, also known as high blood sugar, it leads to problems that surround the circulatory, nervous, and immune systems.
High Blood Sugar and Type 2 Diabetes
When blood sugar levels are consistently high, it can damage the circulatory system in a few ways.
Excess blood sugar can make the walls of your blood vessels sticky and more prone to the build-up of fatty deposits. Over time, these deposits can harden and narrow your arteries, a condition known as atherosclerosis. This makes it more difficult for your heart to pump blood effectively, increasing your risk of heart disease and stroke. Your heart has to work much harder to push blood through these narrowed passages.
Moving through the nervous system, high blood sugar can cause what’s known as neuropathy or nerve damage. Elevated glucose levels can injure the walls of the tiny blood vessels that nourish your nerves, particularly in your legs and feet. You might start to feel tingling, pain, or even numbness. It’s like the nerves are struggling to send messages to your brain and other parts of your body, leading to a loss of sensation or painful sensations.
High blood sugar weakens the immune system by affecting how white blood cells function. These help fight off infections. When your blood sugar is elevated, these cells don’t work as efficiently, making you more susceptible to infections.
This is why people with high blood sugar often find themselves dealing with frequent infections and longer healing times.
Causes of Type 2 Diabetes
The main cause of type 2 diabetes is insulin resistance. Insulin resistance occurs when the body’s cells—particularly those in muscles, fat, and the liver—don’t respond well to insulin and can’t easily take up glucose from the blood.
To compensate, the pancreas produces more insulin, but over time it can’t keep up, and blood sugar levels rise.
A group of lipids called ceramides plays a role in the development of insulin resistance. Ceramides are fat molecules that can accumulate in the body due to poor diet, lack of exercise, and other factors. They interfere with the insulin signaling pathways in cells, making it harder for insulin to do its job.
Type 2 Diabetes Risk Factors
Several risk factors can increase your likelihood of developing type 2 diabetes.
Obesity and a sedentary lifestyle are two significant risk factors for type 2 diabetes. This could involve a poor diet high in processed foods, sugary snacks, and unhealthy fats, which also contribute to weight gain and insulin resistance.
Genetics also play a role in type 2 diabetes. If you have a family history of diabetes, your risk is higher. This doesn’t mean you’ll definitely get diabetes, but be aware of the risk factors and monitor your symptoms.
Symptoms of Type 2 Diabetes
Symptoms of type 2 diabetes can develop slowly and often go unnoticed until they become severe. A few notable symptoms include:
- Increased thirst
- Frequent urination
- Blurred vision
- Unintended weight loss
- Fatigue
- Slow healing sores
- Frequent infections
Be aware of these symptoms and monitor them if they linger or worsen.
Long term Complications
Untreated type 2 diabetes can cause long-term complications like:
- Heart disease
- Stroke
- High blood pressure
- Neuropathy
- Kidney disease
- Eye damage
- Skin complications
- Foot complications
- Limb loss
Management is key to preventing these serious health problems.
Medical Management of Type 2 Diabetes
Managing type 2 diabetes has traditionally involved a multifaceted approach that includes lifestyle changes, medications, and blood sugar monitoring.
These interventions can keep blood sugar stable and prevent complications.
Lifestyle Changes
Your day-to-day lifestyle is the foundation of managing diabetes. Weight loss, healthy eating, and exercise are all part of a plan to successfully manage type 2 diabetes.
Even modest weight loss can improve cholesterol, triglycerides, and blood pressure and lower blood sugar. Reducing sugar and carbohydrate intake is key to controlling blood sugar.
Exercise helps in blood pressure and glucose control. Regular exercise helps control weight, uses up glucose for energy, and makes cells more responsive to insulin.
Some well-known benefits of exercise are:
- Cardiovascular health
- Improved insulin sensitivity
- Weight management
- Stress reduction
Short exercise sessions multiple times per week can give similar cardiovascular benefits as longer exercise sessions only a couple of times per week. To maintain an exercise routine that works for you, choose activities that you enjoy and set specific, attainable goals to keep you motivated.
Diabetes Medications
Type 2 diabetes management often requires medication. Among the most common medications is Metformin, which helps the body respond better to insulin. Metformin works by decreasing glucose production in the liver and increasing insulin sensitivity, which helps lower blood sugar levels.
Another class of medications that has gained popularity is GLP-1 agonists, such as Ozempic and Trulicity. These medications not only lower blood sugar but also reduce appetite. They mimic the action of a hormone called GLP-1, which helps regulate insulin production and helps you feel fuller for longer after meals.
Consistent control over what and how much you eat can lead to more stable blood sugar levels throughout the day.By controlling appetite and food intake, GLP-1 agonists can assist with weight loss and further help control blood sugar.
Blood Sugar Monitoring
Blood sugar monitoring is a large part of routine diabetes management. Monitoring helps prevent complications that come with poorly managed diabetes. A few commonly used tools include blood glucose meters and continuous glucose monitoring systems.
New technologies like automated insulin delivery systems are emerging in glucose monitoring and diabetes management as well.
Bariatric Surgery as a Treatment Option
Bariatric surgery, also known as weight loss surgery, is a procedure that alters the digestive system to help patients lose weight and manage type 2 diabetes. 60-70% of patients who are eligible for this surgery will have a reversal of diabetes.
Types of Bariatric Surgery
Common types of bariatric surgery include Roux-en-Y gastric bypass and gastric sleeve surgery. These procedures reduce the stomach’s capacity for food, leading to significant weight loss and type 2 diabetes symptom reduction.
Eligibility Criteria
Typically a body mass index (BMI) of 35 or higher is required for bariatric surgery, especially for adults with type 2 diabetes. Candidates for bariatric surgery have this BMI requirement, weigh 100 pounds over their ideal weight, and have an obesity-related health condition like type 2 diabetes.
Insurance will cover the surgery if certain medical conditions are present such as:
- High blood pressure
- Sleep apnea
- Heart disease
- Type 2 diabetes
- Joint problems
Post-Surgery Lifestyle Changes
Post-surgery, patients must adopt new eating habits, attend follow-up visits, and be mindful of diet and supplements to avoid nutritional deficiencies.
Medical Management vs. Bariatric Surgery Comparison
Long-term outcomes between medical management and bariatric surgery show a big difference in effectiveness in managing type 2 diabetes.
Many patients benefit from significant and sustained weight loss following bariatric surgery, followed by improvements or resolution to obesity-related health conditions, such as type-2 diabetes. But long-term success will depend on how well a patient can stick to necessary dietary and lifestyle changes and ongoing medical care.
Below, we’ll look at how bariatric surgery fares in aspects like blood sugar control, weight loss results, and potential complications compared to medical management.
Blood Sugar Control
Bariatric surgery offers superior outcomes in managing blood sugar levels compared to traditional medical management. Long-term studies show that patients who undergo bariatric surgery experience a significant decrease in HbA1c levels—an important marker for long-term blood glucose control. The long-term differences are notable, especially around 7 to 12 years post-surgery.
Most bariatric surgery patients achieve Hba1c levels below 7%, which is a standard threshold for controlling diabetes. Seven years after surgery, 54% of these patients had HbA1c levels under 7%, compared to only 27% in the medical management group.
Weight Loss Results
Patients who undergo bariatric surgery often see a significant reduction in their body weight, with an average weight loss of 20% over seven years.
In contrast, those who opt for medical management experience an average weight loss of just 8% over the same period.
Diabetes Complications
The impact of bariatric surgery extends beyond just controlling blood sugar and promoting weight loss; it also significantly reduces the risk of long-term complications associated with diabetes.
For example, long-term studies revealed that seven years after surgery, 18.2% of bariatric surgery patients were in remission, compared to only 6.2% in the medical management group.
Patient Quality of Life
Bariatric surgery offers an effective solution for managing type 2 diabetes, with its many benefits reaching physical, mental, and social well-being.
Physical Health
Effective diabetes treatment can lead to significant improvements in physical health, such as reduced high cholesterol and sleep apnea. Adherence to treatment is linked to fewer physical problems and better overall health.
Mental Health
Strong adherence to diabetes treatment correlates with reduced levels of anxiety and depression.
Psychological well-being improves with consistent treatment, alleviating symptoms of anxiety and depression.
Social Interaction
Better social interaction and functional ability is reported by patients with good adherence to treatment. A strong social support network helps adherence to treatment plans and better overall health outcomes.
Cost and Insurance
When it comes to managing type 2 diabetes, both medical management and bariatric surgery involve significant financial commitments. Understanding the details of the costs involved and insurance criteria will help you make an informed decision about your treatment options.
Cost of Medical Management
The average annual out-of-pocket cost for diabetes management, including medications, provider visits, and supplies, is somewhere between $3,300 and $4,600.
Continuous glucose monitors and other supplies only add to these costs.
Cost of Bariatric Surgery
Bariatric surgery is a significant financial investment. Costs vary between $15,000 and $25,000, not including pre-and post-operative care. Know that bariatric surgery costs will depend on a few things like the type of operation you’re having, any complications, aftercare, fees, and more.
While the upfront costs of bariatric surgery are higher, it can be a cost-effective treatment for patients with type 2 diabetes. Here’s why:
Reduced Medication Costs:
Many patients who undergo bariatric surgery may experience significant improvements in their diabetes, often reducing or even eliminating the need for expensive diabetes medications over time. This can lead to substantial savings on prescription costs.
Fewer Complications:
Bariatric surgery can lead to better overall health by reducing the risk of serious diabetes-related complications like heart disease, stroke, and neuropathy. Avoiding these complications can save thousands of dollars in medical expenses over time.
Long-Term Savings:
Although the initial investment is high, the long-term savings from reduced medication use, fewer doctor visits, and decreased risk of complications make bariatric surgery a financially sound option for many patients.
Insurance
Check with your insurance provider to understand the details of coverage surrounding bariatric surgery.
Insurance coverage criteria for weight loss procedures vary but typically include gastric bypass, sleeve gastrectomy, and gastric banding.
Pre-operative requirements, BMI criteria, and evidence of weight-related health issues are usually standard requirements to be eligible for insurance coverage.
FAQs
What is type 2 diabetes?
Type 2 diabetes is a chronic condition where the body becomes resistant to insulin, resulting in high blood sugar and potential complications to other bodily systems. It can bring serious long-term effects to health.
What are the main differences between medical management and bariatric surgery for type 2 diabetes?
The main difference between medical management and bariatric surgery for type 2 diabetes is that medical management focuses on lifestyle changes and medications while bariatric surgery involves modifying the digestive system to aid weight loss and potentially reverse diabetes. Both aim to improve diabetes, but medical management does not involve surgery.
Who is eligible for bariatric surgery?
If you have a BMI of 35 or higher, especially with type 2 diabetes, you may be eligible for bariatric surgery. However, insurance coverage may require other medical conditions.
What are the long-term benefits of bariatric surgery for diabetes?
Bariatric surgery can offer better glycemic control, a higher rate of diabetes remission, significant weight loss, and fewer long-term complications compared to medical management.
How much does bariatric surgery cost, and is it covered by insurance?
Bariatric surgery costs between $15,000 to $25,000 but many insurance providers cover it, with different eligibility and coverage details per plan.
Contact Nashville Bariatrics Today
Considering bariatric surgery for type 2 diabetes? Nashville Bariatrics can help. With over 10 years of experience and a consistent 5 star review rating, Dr. Patrick Davis offers a personalized consultation to determine the best surgical options for you.
We provide self-payment options and financing plans for patients without insurance coverage or whose procedures are not covered.
Set up a consultation today to discuss how bariatric surgery can transform your life.
Visit Nashville Bariatrics at 393 Wallace Rd Ste 301, Bldg A Nashville, TN 37211, or call us at 615.425.0550.
Dr. Davis and his team are ready to guide you toward a healthier lifestyle.