Rigorous study confirms what TMC bariatric surgeons preach about surgery benefits for diabetics

A recent study done at the University of Minnesota and published in the Journal of the American Medical Association suggests bariatric surgery is a more effective way to reduce and even reverse diabetes than medication and lifestyle changes.  The findings, which came from one of the most rigorous studies of its kind, could lead to changes in who qualifies for the surgery.

Dr. Scott Welle TMC Bariatric Surgeon

Dr. Scott Welle
TMC Bariatric Surgeon

TMC Bariatric Surgeon Dr. Scott Welle said the research corresponds with exactly what he and other bariatric surgeons have said all along – that weight loss surgery is an effective tool for getting diabetes under control and even having it go into remission.  “It’s a lot more common for people to come into my office saying they want to get off their diabetes medicine rather than wanting to lose the weight.  Losing the weight is just the bonus.”  Type 2 diabetes affects more than 20 million Americans.  Most of these patients are overweight or obese, and are at a higher risk for heart disease and stroke, among other things.  Diabetes that is not controlled properly can damage the kidneys, eyes and blood vessels.

The yearlong study indicated that gastric bypass, the most common bariatric surgery in which the stomach is stapled to create a small pouch and attached to a lower part of the intestines, can effectively treat diabetes in patients who are considered mild to moderately obese.  “We’re finding this especially true for patients with a lower BMI, who are about 50 to 70 pounds overweight.  Our overall success rate is more effective with this patient population typically because they haven’t been diabetic as long as patients who are morbidly obese,” said Dr. Welle. 

To qualify for weight loss surgery outside of a research institution, a patient must have a BMI of at least 35, and a comorbid condition like diabetes, hypertension, or sleep apnea.  That magic number, 35, Dr. Welle explained, was recommended from the National Institutes of Health in the early 1990’s.  Newer research, which looks at treating people with a lower BMI, may lead to updated recommendations if the surgery is proven to be safe and effective.

“We’re starting to see these patients when they just barely qualify for surgery based on their BMI.  They’re coming in when they’re 80 to 100 pounds overweight, for example, wanting to get off their diabetes medication rather than waiting until they’re 300 pounds overweight,” he said.

Even then, Dr. Welle said, he and his team are not quick to operate.  “It’s not like diabetic patients come into our office, and we schedule a surgery date.”  The amount of time from the consultation to the actual surgery day can range from two to eight months.  There is a pre-authorization and pre-screening process.  Patients are given a psychological evaluation, and undergo nutritional counseling.  The pre-op workup is intense.  Plus, by the time a patient even hits his door, they’ve typically put considerable thought into their decision.  “Nine times out of ten, someone who presents for bariatric surgery has been thinking about it for at least five years on average,” he said. 

clip_image002Since 2011, TMC has been a Bariatric Center of Excellence, an accreditation from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).  All bariatric surgeries performed at TMC are minimally invasive, and some are even done using the da Vinci surgical robot.  Dr. Welle said the surgery requires a one-to-two-day hospital stay,  and oftentimes patients are off their diabetes medication by the time they are discharged.  “Yes, it happens that quickly with metabolic procedures like gastric bypass.  A majority of my patients leave the hospital off their diabetes medication.”  Most patients resume their normal lifestyle in one to two weeks.

The study did mention an alarming complication rate.  About a third of the 60 adults who underwent gastric bypass developed serious problems within a year of the operation, although some cases were not directly linked to the surgery.  For more serious complications, including infections, intestinal blockages and bleeding, the rate was six percent. 

“If you look at the study, the number of people who had a complication in the surgery group was 22 out of 60.  If you look at the non-surgical group, 15 of those 60 people also had a complication.  It’s important to realize that no deaths were reported.  So when we say bariatric surgery is safe and effective, it truly is.  When you see high complication rates like this in a study, you need to really delve in and look at how strict they’re classifying their complications,” Dr. Welle said.  Patients in the surgery group ended up using an average of three fewer medications than patients in the non-surgical group.  “That’s medications for diabetes, high blood pressure, and high cholesterol.  It’s not just diabetes, rather the gamut of the metabolic syndrome that can be treated effectively with bariatric surgery,” Dr. Welle explained.

For more information about TMC’s Bariatric program, please click here.

Comments

  1. Norma Ross says:

    How can I find Dr.Welle,he did my surgery, and I’m very happy with it.but he moved from his offoce.I have been trying to fined him so I can continue being his patient

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