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Can Surgery Cure Diabetes?

By Brian M. Carty, MD, MSPH

February 14, 2008

"A chance to cut is a chance to cure" is the surgeon's motto. That bariatric (obesity) surgery for severe obesity often cures diabetes is not new information. What is new is research which shows that bariatric surgery can also cure diabetes in people with mild or moderate obesity. Even so, surgery is not usually considered a first line treatment for the severely obese diabetic, much less for the mildly or moderately obese diabetic. This attitude is likely to change.

Obesity and diabetes are common, serious, and interrelated problems. Obesity greatly increases the risk of developing type II diabetes. Type I diabetes is not usually associated with obesity, is not curable with surgery, and will not be discussed further here. While weight loss can improve or even cure type II diabetes, diet and lifestyle changes almost never result in significant, sustained weight loss. Furthermore, despite treatment with medications, diabetes usually causes progressive organ damage and sometimes blindness, kidney failure, amputation, or death.

The severity of obesity can be classified by the body mass index (BMI), which is the weight in kilograms divided by the height in meters squared. BMI can be obtained from this online calculator. Here are BMI ranges for normal weight, underweight, and different degrees of obesity:

	BMI
Underweight	<18.5
Normal	18.5-24.9
Overweight	25.0-29.9
Obesity	30.0-34.9
Severe Obesity	35.0-39.9
Morbid Obesity	40.0-49.9
Super-morbid obesity	>50.0

Until recently, bariatric surgery was generally restricted to patients with a BMI of 40 or greater or a BMI of 35 or greater along with obesity related medical problems such as high blood pressure, diabetes, or sleep apnea. Government programs and insurance companies usually will not pay for the operation unless these criteria are met.

The number of bariatric operations done in the US has greatly increased in the past several years. You may know someone who has had such an operation. You may even know someone who has had to fight it out with an insurance company to get the operation approved.

The results of a recent study (Jan. 23 JAMA) challenge the practice of offering bariatric surgery only to patients who meet the standard criteria. In this study, bariatric surgery cured diabetes in over 70% of diabetics with mild or moderate obesity (BMI between 30 and 35). Thus, bariatric surgery should be considered for diabetics with mild or moderate obesity (BMI 30-35) as well as for diabetics with severe obesity (BMI over 35).