Dr.Chirag Thakkar

Diabetes: Does Surgery have any role in treatment of Diabetes? What is Metabolic Surgery?

Are you suffering from diabetes? Do you want to get rid of medications? Every diabetic person wishes to get rid of their daily medications and injections. While it may not be possible for all, a selected group of diabetic patients can achieve this with the help of metabolic surgery. Some of them can completely get rid of medications, while some may get freedom from insulin while still requiring medication. More importantly, here metabolic surgery has an important role in the treatment of diabetes. This comes with even better blood sugar control. Read the article to understand this in detail.

Diabetes currently affects more than 150 million people worldwide and that number is expected to quickly increase. Over 90% of people with the disease have Type II form, which is associated with obesity and overweight, lack of physical activity, family history, and older age. Unlike Type I diabetes in which the pancreas fails to produce sufficient insulin, the pancreas in patients with Type II diabetes produces enough insulin, but for unknown reasons, the body is unable to use the insulin. Diabetes can lead to blindness, heart, and blood vessel disease, strokes, kidney failure, amputations, and nerve damage. Current therapies, which include diet, exercise, oral antidiabetic drugs, and insulin, do not always cure the disease.


The goal of treatment is to improve the symptoms of diabetes through normalizing blood glucose levels. The ongoing goals are to prevent long-term complications like eye and kidney disease, damage of nerves, and blood vessels. The strict control of blood glucose reduces the risk of death, stroke, heart failure, and other complications. Glycosylated haemoglobin (HbA1C) is a test that determines the risk of long-term complications. It measures how much glucose has been sticking to red blood cells and other cells.

First-line treatment for type II diabetes

The first-line treatment for type II diabetes is weight loss, diet, and exercise. Appropriate meal planning includes choosing healthy foods and eating the right amount of food. Exercise is important for effective treatment of diabetes. Regular exercising helps burning excess calories, managing weight thus improves control of the glucose amount in the blood.

Second-line treatment for type II diabetes

When diet and exercise are not sufficient to maintain normal blood glucose levels, medications may be needed. They work through triggering the pancreas to make more insulin, helping insulin work better, decreasing the absorption of carbohydrates from the gut, or decreasing glucose production in the liver.

Third-line treatment for type II diabetes

Poor blood glucose control despite lifestyle changes and taking medications means insulin should be injected.

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Role of Surgery

Despite continuing advances in diabetes pharmacotherapy, fewer than half of adults with type II diabetes mellitus (T2D) attain therapeutic goals designed to reduce long-term risks of complications, especially for glycemic control, and lifestyle interventions are disappointing in the long term. Metabolic surgery, on the other hand, has been shown to improve glucose homeostasis more effectively than any known pharmaceutical or behavioural approach.

For the patients having diabetes for less than 5 years, there is a high likelihood of achieving normal blood sugar levels without any medications. If the person is obese and not yet requiring Insulin his chances of complete stoppage of medication and still achieving normal sugar levels are very high. If they are having very poorly controlled diabetes, are on a high dose of insulin, and are having diabetes for a very long time, surgery helps in achieving normal sugar levels with decreased requirements of Insulin and medications. Such patients may still need medications but they can achieve good glycemic control leading to the prevention of diabetes-related complications

While Metabolic surgery( Surgery for Diabetes) certainly has some risk, the long-term risk of continued diabetes (which is often inadequately treated with medication) typically outweighs the risk of a surgical procedure for most patients. Each patient’s individual risks for surgery, though, should be evaluated in the context of the duration and severity of their diabetes as well as their other obesity-related health problems.


A key finding of many studies is that the shorter the history of diabetes, the greater the likelihood of complete remission. Glucose toxicity, particularly in poorly controlled diabetes, accelerates B-cell failure. B-cells are located in the pancreas and produce and secrete insulin. Weight loss can improve B-cell responsiveness to glucose. If the bariatric surgical procedure is performed before irreversible B-cell failure has occurred, durable weight loss will be accompanied by a high likelihood of long-term remission.


There are various metabolic/bariatric procedures available to you. Each one is having certain benefits and some negative aspects. You should understand each one in detail and discuss with your surgeon which one is best suited for you. The choice of procedure will depend on your weight, BMI, medical problems, age, and your expectation from this surgery.

For more detail, you can read our articles related to obesity and diabetes.

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