WHO ARE THE RIGHT CANDIDATES FOR TYPE2 DIABETES SURGERY?
The patients with diabetes type 2 having obesity (BMI>30) could be treated with a bariatric surgery. Surgical operation is not a treatment option for diabetes type 1.
In 2016, many international organizations working on diabetes, including the American Diabetes Association, decided that bariatric surgery should be included in the treatment of Type 2 diabetes.
Candidates for surgery can be obese patients whose blood sugar levels couldn`t be regulated during their initional attempt for lifestyle and nutritional change combined with standard medication treatment
It is usually performed on patients with a body mass index above 30. Success rates are low at patients without obesity.
Eventhough type 2 diabetic patients with age range of 18-65 may be candidates for surgery, more successful results are obtained at patients under the age of 50 and whose duration of diabetes is less than 10 years.
The patients surgical suitability is inevitably evaluated by Endocrinology and Metabolism Diseases Specialists. There are two discussable questions which answers must be found in first place.
1-Have the patients tried out the treatment opportunities adequately? This question should be answered. Because of the fact that eventhough non-operative methods take great efforts, they are stil with less risks. It is not considered appropriate to undergo a surgery for a diabetes which level can be controlled with some of the standard non-surgical treatments.
2-Are the insulin reserves of the patients sufficient in order to benefit from the surgery? This question must be answered in advance too. Because surgery can be effective and useful for situations in which insulin is present but insufficiently produced , secreted or ineffectively absorbed inside the tissues. In the absence of the pancreas's ability to produce insulin, surgery will not be successful. Respectively, the serum level of C-peptide is to be examined. The normal range is 1.1-4.4 ng / mL. It is preferred that the C-peptide level is above 3 ng/mL in order a beneficial, successful surgical outcome to be achieved.
* It is recommended that all type 2 diabetes patients with a severe body mass index of over 40 (class III) obesity should undergo a surgery.
* Body Mass Index 35-40 (class II) patients with obesity facing difficulty in controlling the blood sugar level with standard treatments are recommended to have a surgery.
* Patients with Body Mass Index between 35-40 and whose blood sugar level is put under control with standard treatments may consider surgery.
* Patients with a Body Mass Index between 30-35 having difficulty in controlling blood sugar levels with standard treatments may also consider surgery.
-Surgical operation is not a treatment option for diabetes type 1 patients.
-Surgical treatment is not suitable for diabetic patients with a Body Mass Index below 30 (without obesity).
-Since the risk for surgery at patients with coronary artery disease, heart attack, and coronary bypass surgery is higher, therefore the results of cardiology consultations and the possibility for potential benefit from the surgery should be carefully evaluated before taking final decision.
-Patients with severe renal impairment, dialysis patients, patients with excessive protein loss from the urine tract are more risky in terms of surgery. The decision should be made after consultation with the nephrology department.
The results are more successful in patients with HbA1c levels below 8%. It is in the best interest of the patient to make an immediate surgical decision in case of ongoing progressive diabetes complications despite undertaking standard medical treatments. These complications include eye (retinopathy), kidney (nephropathy), nerve (neuropathy) disorders due to diabetes.
In order to control the disease at a relatively early stage, patients who meet the criteria listed and whose insulin production reserve in their pancreas is still preserved should be offered the chance for a surgery. This surgery is not the final solution for diabetic patients who have exhausted all the reserves, but it should be considered as an effective alternative co-solution for uncontrolled diabetes before coming to a such of phase.