Metabolic Surgery (For Diabetes)

Metabolic surgery refers to a group of surgical procedures primarily aimed at treating or managing metabolic diseases such as type 2 diabetes, rather than focusing solely on obesity. Although these surgical approaches are often similar to bariatric (obesity) surgery techniques, the main goal here is not just weight loss. Instead, the objective is to positively affect hormonal and metabolic processes, regulate blood sugar levels, and reduce the risk of complications associated with diabetes. Metabolic surgery is considered a promising treatment option for patients with type 2 diabetes who cannot achieve sufficient control through medication and lifestyle changes.

When Is Metabolic Surgery Considered (For Diabetes)?

Metabolic surgery may be considered for patients with type 2 diabetes who meet certain criteria. Commonly evaluated situations include:

• Uncontrolled Type 2 Diabetes: Patients whose blood glucose levels remain outside the target range despite treatment with medications (oral antidiabetics and/or insulin) and lifestyle modifications.
• Coexistence of Obesity and Type 2 Diabetes: Patients diagnosed with type 2 diabetes and a body mass index (BMI) above a certain threshold (usually 30 or more). Some guidelines also consider patients with a BMI between 30–35 and uncontrolled diabetes.
• High Risk of Diabetes-Related Complications: Patients with a high risk of serious diabetes-related complications, such as heart disease, kidney failure, or nerve damage, and who struggle with blood sugar control.
• Patients with High Insulin Resistance: Those who are on high doses of insulin yet still unable to control blood glucose levels, often due to insulin resistance.
• Diabetes Accompanied by Metabolic Syndrome: Patients who, in addition to type 2 diabetes, have other components of metabolic syndrome such as hypertension and high cholesterol.

The decision for metabolic surgery should be made using a multidisciplinary approach (involving an endocrinologist, general surgeon, dietitian, psychologist, etc.) and should consider the patient’s overall health status, the severity of diabetes, treatment response, and compliance with lifestyle changes.

How Is Metabolic Surgery Performed (For Diabetes)?

Several surgical procedures are used in metabolic surgery. While many of these procedures resemble those used in bariatric surgery, they primarily focus on metabolic effects. In Türkiye, some of the legally approved and commonly performed metabolic surgery procedures with proven positive effects on type 2 diabetes include:

• Roux-en-Y Gastric Bypass (RYGB): A small pouch is created at the upper part of the stomach and connected directly to a lower part of the small intestine. This restricts stomach capacity and limits contact between nutrients (especially glucose) and the upper small intestine, leading to hormonal changes and improved glycemic control.
• Sleeve Gastrectomy: A large portion of the stomach is removed, leaving a narrow, tube-shaped stomach. This not only reduces stomach capacity but also decreases the production of the hunger hormone ghrelin, which helps control appetite and supports metabolic improvements.
• Mini Gastric Bypass (MGB) / One-Anastomosis Gastric Bypass (OAGB): Similar in principle to Roux-en-Y gastric bypass, but involves a simpler anastomosis (connection). Its efficacy and metabolic outcomes are comparable to those of the Roux-en-Y procedure.
• Biliopancreatic Diversion (BPD) and Duodenal Switch (DS): These are more complex procedures that both restrict stomach capacity and significantly reduce nutrient absorption. They have shown high rates of improvement in type 2 diabetes but carry a higher risk of nutritional deficiencies.

These surgeries are typically performed laparoscopically (minimally invasive), using small incisions in the abdominal area. The choice of surgical method depends on factors such as the patient’s overall health, BMI, the severity of diabetes, and is determined by a multidisciplinary team.

Recovery Process After Metabolic Surgery (For Diabetes)

The recovery process after metabolic surgery varies depending on the surgical method used and the patient’s overall health condition. Generally, it includes the following phases:

• Hospital Stay: Patients typically stay in the hospital for a few days after laparoscopic surgery. During this period, pain management is provided, fluid intake is initiated, and blood glucose levels are closely monitored.
• Initial Weeks: After discharge, patients are usually advised to follow a diet of liquids and pureed foods for the first few weeks. Physical activity is gradually increased. Rapid improvements in blood glucose levels may be observed, and medication dosages may need adjustment.
• Gradual Transition to Solid Foods: Under medical and dietary guidance, patients slowly transition to a normal, healthy diet.
• Long-Term Follow-Up: Long-term follow-up and multidisciplinary support (endocrinologist, dietitian, etc.) are essential for maintaining blood glucose control, managing potential complications, and ensuring adherence to lifestyle changes.

Postoperative Nutrition and Lifestyle Changes (For Diabetes)

To ensure the lasting benefits of metabolic surgery on type 2 diabetes, adherence to post-surgery dietary and lifestyle changes is crucial. These include:

• Healthy and Balanced Diet: Eating small, frequent meals and avoiding processed foods, sugary drinks, and high-glycemic-index foods is essential. A diet rich in protein, fiber, and healthy fats should be adopted.
• Regular Exercise: Engaging in regular physical activity as advised by the doctor improves insulin sensitivity and supports blood sugar control.
• Medication Use: Although blood sugar levels may improve significantly after surgery, continuing or adjusting diabetes medications as per the doctor’s recommendation may be necessary. Some patients may eventually no longer need medication.
• Regular Medical Check-ups: Attending regular follow-up appointments is vital for monitoring blood sugar levels, detecting potential complications early, and ensuring overall well-being.
• Education and Support: Receiving education on diabetes management and participating in support groups can contribute to long-term success.

Potential Risks and Complications of Metabolic Surgery (For Diabetes)

While metabolic surgery is an effective approach for managing type 2 diabetes, like all surgical procedures, it involves certain risks and possible complications. These vary depending on the surgical method, the patient’s overall health, and other factors. Potential risks and complications may be similar to those associated with bariatric surgery and include bleeding, infection, anastomotic leakage, thromboembolic events, nutritional deficiencies, and dumping syndrome. However, the potential benefits of metabolic surgery—such as controlling or even reversing diabetes and reducing the risk of diabetes-related complications—must be carefully weighed against these risks.

Before deciding on metabolic surgery, patients should be thoroughly informed and evaluated by a multidisciplinary team. Regular postoperative follow-up and adherence to medical advice are crucial for both diabetes control and the management of potential complications.

Disclaimer: All content on this site is for informational purposes only and is based on scientific sources valid at the time of publication. For any symptoms, diagnoses, or treatments related to health, please consult your physician or a certified healthcare provider.