Weight Loss Surgery for Diabetics

If you're overweight and just can't seem to shed the unwanted pounds, you may be wondering whether surgery could be helpful in your quest to lose weight and get your blood sugar back in the normal range. Before you make a decision, weigh all the options. Many choices are available today to diabetics who opt for weight loss surgery, each with pros and cons.

Here's a rundown of what surgical options are out there. For each, the success rate means how many patients successfully lost and kept off the weight over time.  

Gastric bypass surgery: The procedure involves stapling the stomach, creating a little pouch and a passageway for the food to bypass part of the small intestine.

This is the "gold standard" of weight loss surgeries, says Vadim Sherman, MD, a bariatric surgeon at Methodist Hospital in Houston, Texas. The success rate is high, about 70 to 80 percent of patients who have gastric bypass surgery continue to keep off the weight for 20 to 30 years, he says. Sherman says gastric bypass "has been shown to be the only surgery to resolve diabetes before any weight loss has even occurred." And, he adds, sometimes he sees patients have normal blood sugars even before they leave the hospital.

Gastric band surgery, (also known as Lap-Band adjustable gastric banding): This option is often a good choice for a recently diagnosed diabetic, says Mitchell Roslin, MD, chief of bariatric surgery at Northern Westchester Hospital in Mt. Kisco, New York.

To perform this, an inflatable band is put into place and divides the stomach into two parts as it wraps around the upper part. Once pulled tight, the band restricts the amount of food a person can eat. "We put a belt on the stomach that has a balloon inside and the balloon squeezes the stomach," Roslin explains. While it's simpler than the other surgeries and has a lower rate of complications, it's not as effective.

Individuals who have the gastric band surgery tend to lose less weight and to lose it more slowly than those who have the more radical procedures. The success rate is about 50 to 60 percent, Roslin says. This procedure also has the highest reoperation rate, he adds.

Duodenal switch: This is a more intense operation with a higher rate of complications. In this procedure, about 80 percent of the stomach is removed. A valve that lets food into the small intestine remains, as does a portion of the small intestine. But the majority of the intestine is bypassed during the operation, which connects the intestine's end portion to the duodenum near the stomach.

"Technically it is a more demanding operation but it has a high success rate - about 95 percent," Roslin says. "And it can be done laparascopically." Patients who've had this procedure are at a higher than average risk of malnutrition, and some report diarrhea as well, Sherman explains.

Sleeve gastrectomy: With this procedure, in order to limit the number of calories your body can absorb, the stomach's structure is modified so that it looks like a tube. "It makes the stomach look like a banana rather than a kidney," says Roslin. "And you can easily go from a sleeve to a duodenal switch." In fact, for certain patients, a sleeve gastrectomy is performed to facilitate weight loss in a patient before the duodenal switch is performed.

The success rate is about 80 percent. This is a newer procedure, Sherman says, and one potential drawback is that since it is so new, "we don't know the long term effects or how durable it is," Sherman says.