Bariatric surgery can treat complications in people with obesity and diabetes

The long-term impact of diabetes

Diabetes is a chronic condition. It is related to the hormone insulin and the body’s ability to use glucose (sugar) for energy.

Without proper management, diabetes can lead to several long-term complications. For example, one complication is peripheral neuropathy, which is nerve damage that affects the feet, legs, arms, and hands.

Another is retinopathy, which ultimately causes damage to the eyes and vision problems. Finally, cardiac autonomic neuropathy involves damage to the nerves that control the heart. These areas of damage can lead to poor health outcomes and diminished quality of life.

Dr. Denise Pate, a board-certified physician and Medical Director with Medical Offices of Manhattan, not involved in the current study, offered further insight into the damage caused by peripheral neuropathy:

“Peripheral nerves function to detect sense of touch, pain, temperature once these nerves become damaged from excess blood sugar the body loses the ability to detect such stimuli. This can lead to pain and equally worse can put a diabetic at risk for not recognizing small injuries to their extremities. These small injuries can lead to skin and bone infection and ultimately to the risk of amputations.”

Benefits of bariatric surgery in diabetes

T​his prospective cohort study looked at how bariatric surgery impacted diabetes complications and the improvement of metabolic risk factors. Metabolic risk factors studied included several components, including blood glucose levels, cholesterol, and weight.

The study included 79 participants that completed the 2-year follow-up after undergoing bariatric surgery. All participants had class 2 or 3 obesity.

After 2 years, the data showed an improvement in peripheral neuropathy. Retinopathy and cardiac autonomic neuropathy were stable. Researchers also found improvement in quality of life and pain among participants.

There was an improvement in most of the metabolic risk factors, including weight reduction. They further found that improvement in fasting glucose levels was associated with improvements in retinopathy.

The study results indicate the potential benefits of bariatric surgery, including improving peripheral neuropathy. Dr. Ali noted that “[t]his study affirms findings of previous studies that show surgical weight loss has many benefits for those patients that qualify, not the least of which is improving medical conditions such as diabetes.”

Study author and associate professor of neurology Dr. Brian Callaghan, from the University of Michigan Health, explained some of the clinical implications of the research to MNT:

“Bariatric surgery leads to impressive weight loss and metabolic improvements such as diabetes and cholesterol. This surgery also improves peripheral neuropathy including the pain and quality of life problems that are caused by peripheral neuropathy. Bariatric surgery should be considered for patients with obesity that are unable to lose weight through diet or medications. We have known for a while that this surgery improves metabolic issues like diabetes, but we are now learning more about the neurologic benefits.”

When bariatric surgery is recommended

Some people with type 2 diabetes may also have obesity. These combined factors may lead doctors to recommend certain surgical interventions

Bariatric surgeries can aid in maintaining weight loss, and there are a few different bariatric surgery options. These options may be helpful for people who have had difficulty losing weight through other means like diet and exercise.

Bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, Dr. Mir Ali, not involved in the study, explained to MNT that “[t]he indications for bariatric surgery currently accepted by most insurance carriers is a BMI [greater than] 40 or 35 with additional comorbid conditions, such as diabetes, hypertension, or sleep apnea.”

“The goal with surgery, which has been demonstrated in many studies, is to resolve or improve comorbid conditions, increase life expectancy, and improve the quality of life,” he added.

Study limitations and continued research

The study did have some limitations. First, it only included a small number of participants and did not include a control group. The researchers also had difficulty obtaining follow-ups from some of the individuals who underwent bariatric surgery.

Then, they were also limited by the follow-up time, indicating the need for studies looking more at the short-term effects and ones that provide even longer follow-ups. Over 98% of the participants were non-Hispanic, and over 73% were women, indicating the need for future studies with more diversity.

The study cannot establish a causal relationship between the factors the researchers examined. Researchers further noted that they only used specific assessments of peripheral neuropathy, so further depth of research in this area may be warranted.

D​r. Pate offered the following cautions when looking at the study’s results: “The type of bariatric surgery was also not well evaluated in that of the 79 patients, 71 underwent sleeve gastrectomy and 8 underwent gastric bypass surgery. Since the type of procedure was not further evaluated for the outcome it can be concluded that weight loss, in general, was key to the results not necessarily the way by which the weight loss occurred.”

Dr. Callaghan noted that he and his colleagues “are currently conducting a study to see whether exercise, bariatric surgery, or both helps peripheral neuropathy the most.”

“This is a randomized trial that will provide even more robust data on the effects of exercise and bariatric surgery on peripheral neuropathy,” he told us.