Every day during consultations I meet patients with the same story. A person has lived with obesity for many years, takes several medications for diabetes, the blood glucose level still remains unstable, and the number of medications gradually increases.
Patients ask me the question: “Is it possible to cure diabetes?”
As a bariatric surgeon, I answer: we do not use the word “cure”, but we can achieve remission of the disease - and quite often.
What happens to diabetes after bariatric surgery
Over the past twenty years, a huge number of studies have accumulated showing that metabolic (bariatric) surgery affects not only weight but also metabolism.
After procedures such as sleeve gastrectomy or gastric bypass, several key changes occur in the body:
- insulin resistance decreases significantly
- the hormonal profile of the intestine changes
- tissue sensitivity to insulin improves
- blood glucose levels normalize
Interestingly, improvement in blood sugar often occurs even before significant weight loss. This indicates that bariatric surgery is not just a way to lose weight, but a full-fledged metabolic treatment for diabetes.
What modern studies show
The results of clinical studies confirm what we observe in practice.
A large meta-analysis of randomized studies showed that one year after bariatric surgery, diabetes remission is observed in about 53% of patients, whereas with standard medical therapy it occurs in only about 5% of patients.
In other words, the probability of achieving remission after surgery is more than eight times higher than with conservative treatment.
Similar results were shown in another long-term study comparing patients after bariatric surgery with patients receiving only medical therapy. Patients who underwent surgery achieved remission of diabetes much more often and required glucose-lowering medications significantly less frequently.
Moreover, the effect can last for many years. Observations lasting up to ten years show that a significant proportion of patients maintain normal glucose levels and significantly reduce the need for antidiabetic medications.
Why surgery works better than pills
From a physiological point of view, the explanation is quite simple.
Type 2 diabetes is not only a disease of high blood sugar. It is a deep metabolic disorder associated with:
- visceral fat
- intestinal hormones
- insulin resistance
- inflammatory processes in the body
Bariatric surgery affects all these mechanisms simultaneously.
After surgery:
- the stomach volume decreases
- the passage of food through the intestine changes
- the secretion of hormones GLP-1 and PYY increases
- appetite decreases
- tissue sensitivity to insulin improves
In essence, we “reset” the body’s metabolic system.
When the probability of remission is highest
Over years of practice, I have noticed an important pattern that is also confirmed by scientific studies.
The best results are observed in patients:
- with relatively recent diabetes
- without long-term insulin therapy
- with preserved β-cell function of the pancreas
- when surgery is performed early
Studies show that β-cell function and the degree of weight loss after surgery are directly related to the chances of diabetes remission.
That is why today many international guidelines consider metabolic surgery not as a “last step”, but as an effective method of treating diabetes in patients with obesity.
What patients should understand
Despite the impressive results, surgery is not a “magic pill”.
For diabetes remission to last for many years, the patient must:
- change eating habits
- have regular medical follow-ups
- monitor laboratory tests
- maintain a healthy lifestyle
But when a person follows these recommendations, the results can be truly impressive.
I often observe how patients who have lived with diabetes for years and depended on several medications stop taking them just a few months after surgery and see normal blood sugar levels.
