Surgeons in the 1950s already reported that following certain gastric operations a dramatic improvement of diabetes was observed. Today a worldwide epidemic of type 2 diabetes is witnessed. In 2007 246 million people were affected by diabetes worldwide and by 2025 this number will increase to 380 million. The primary cause of type 2 diabetes is thought to be an autoimmune process that gradually destroys pancreatic beta the cells that are responsible for insulin production. In morbidly obese individuals an increased peripheral insulin resistance is usually also present, which means, that the limited amount of available insulin has even further reduced effect. Insulin is the primary modulator of blood glucose levels. But insulin has many other metabolic effects that are less well understood and it appears that healthy insulin levels are critical for our well-being.

How powerful are these procedures in treating diabetes?

Various metabolic operations have a varying degree of affect on the remission of type 2 diabetes mellitus. Perhaps the most powerful operation to treat diabetes is the biliopancreatic diversion with duodenal switch. That procedure is not performed in Massachusetts due to concerns about unwanted side effects and very strict vitamin and nutrient regimens, that are difficult to follow.
The Roux-en-Y gastric bypass procedure brings type 2 diabetes into remission in over 80% of patients. The sleeve gastrectomy is less effective in the treatment of type 2 diabetes, somewhere between 60 and 80%, depending on the patient population and the length of follow-up. Studies suggest that patients whose diabetes was diagnosed within the past 5 years and are not using insulin yet would experience the best outcome in terms of complete remission of their disease. Type 2 diabetes is a progressive disease and involves the destruction of pancreatic B the cells. If all the B cells are destroyed in the pancreas then the surgery is not going to be effective but due to the weight loss effect and the associated metabolic changes, the insulin requirement could still be significantly lower.

Biliopancreatic diversion with duodenal switch