Although the exact cause is not known, type 2 diabetes is linked to obesity. For people who are very obese or unable to lose weight, bariatric surgery for obesity, often called metabolic surgery, can achieve weight loss and may improve diabetes control and sometimes put it into remission. This means that blood sugar levels will fall and may even return to normal without the need for medication.
What are the Types of Metabolic Surgery?
Today, metabolic surgery is done using small incisions on the abdomen, and scopes that allow the surgeon to see inside. The two most common types are:
- Sleeve gastrectomy – removes part of the stomach, making you feel full faster
- Roux-en-Y gastric bypass – changes the way food moves through the stomach and intestines.
How does it work?
Hormone Changes
People with type 2 diabetes often begin to show improved blood sugar levels immediately after metabolic surgery, before any weight loss. This is thought to be partly due to changes in gut hormones (incretins), especially GLP-1. Metabolic surgery sharply increases GLP-1 secretion after a meal, which helps stimulate insulin release from the pancreas to reduce glucose spikes.
Reduction in Liver and Pancreatic Fat
Fat in the liver causes it to make too much glucose even when insulin is present. Studies that compared fat content in the liver before and after metabolic surgery showed a significant decrease before any major weight loss.
This is similar to what happens in the pancreas. Fat buildup in the pancreas disrupts the function of beta-cells (the cells responsible for producing and releasing insulin), which leads to high blood sugar. After metabolic surgery, fat in the pancreas is also reduced, allowing the insulin-producing cells to regain their ability to make insulin.
Other Health Benefits
Metabolic surgery doesn’t just help with improving blood sugar levels, it can also:
- Improve blood pressure and cholesterol levels
- Reduce harmful inflammation in the body
- Reduce other problems due to obesity such as arthritis and sleep apnea
- Possibly lower the risk of heart disease and stroke
- Possibly improve overall health
Things to Keep in Mind
Even though surgery can offer powerful benefits, it’s not right for everyone. It carries risks like nutrient deficiencies and surgical complications. And for long-term success, it still requires healthy eating, regular activity, and medical follow-up.
About the author
Ali Abdalbari
Ali Abdalbari is a graduate research trainee at the University of Ottawa Heart Institute focused on the intersection of type 2 diabetes, obesity, and cardiovascular disease. He is passionate about translating scientific discoveries into meaningful clinical insights for novel diabetes management and treatment avenues and is actively engaged in metabolic disease research.
