IF you have been diagnosed with type 2 diabetes and obesity, here are reasons to consider bariatric surgery.
According to the New England Journal of Medicine, bariatric surgery is superior to intense medical therapy in the remission of type 2 diabetes.
Evidence suggests that surgical intervention soon after diagnosis of type 2 diabetes offers a better chance for remission than does surgery after an extended period following diabetes onset.
Patients with type 2 diabetes who have bariatric surgery have about a 50% lower risk of having complications related to diabetes (blindness, need for dialysis and amputations).
If you have had type 2 diabetes and have related health conditions, you might be a candidate for surgery.
Recent evidence suggests that you may have a change for remission, to decrease diabetes medicines and to reduce your risk of having future medical problems related to diabetes.
John D. Scott, MD is here to discuss Type 2 Diabetes: What’s right for you? Consider all of the options.
Selected Podcast
Type 2 Diabetes and How Bariatric Surgery Can Help
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Learn more about Dr. John D. Scott
John D. Scott, MD
Dr. John D. Scott holds a Bachelor of Arts in biology from Baylor University and a Master of Science in molecular cell sciences from the University of Memphis. He attended medical school at the University of Tennessee Health Science Center in Memphis, graduating in 2001. In 2006, he completed his residency in General Surgery at the Greenville Health System in South Carolina. Dr. Scott completed a fellowship in advanced minimally invasive and bariatric surgery at the University of Cincinnati. During his fellowship, he gained significant experience in weight-loss surgical techniques as well as advanced training in minimally invasive hernia, gastrointestinal and endocrine surgery. Dr. Scott joined the University of Tennessee faculty as Assistant Professor of Surgery in July, 2007. He decided to return to his surgical home in Greenville at the Greenville Health System in September, 2008. His clinical practice and academic work concentrate on minimally invasive surgery.Learn more about Dr. John D. Scott
Transcription:
Melanie Cole (Host): If you are an obese person and you have been diagnosed with Type II diabetes, there are some very important reasons that you might want to consider bariatric surgery. My guest today is Dr. John Scott. He is a bariatric surgeon at Greenville Health System. Welcome to the show, Dr. Scott. Tell us a little bit about Type II diabetes as it relates to obesity and then we’ll get into bariatrics.
Dr. John Scott (Guest): Sure. Well, thank you for having me on. Type II diabetes runs hand in hand with morbid obesity. Your chances of becoming a Type II diabetic go up almost 30 times if you are obese as opposed to being a normal weight individual.
Melanie: Is this something that is easily dealt with? We hear about Type I diabetes and how difficult that is to titrate your insulin levels with your exercise and diet. But Type II, people say, is a lifestyle and sedentary behaviors. Is this something that is so difficult to control that that’s when a person needs to really consider interventions?
Dr. Scott: Certainly Type II diabetes is a chronic medical condition. Medical doctors that take care of patients with Type II diabetes are getting much better at managing the disease. As far as getting somebody to go into remission from that, bariatric surgery offers people an opportunity to get rid of their diabetes completely and get off medications. The ability to get rid of your diabetes is independent of weight loss. People, after they have bariatric surgery, their diabetes can go away within weeks to months even before a lot of weight loss takes place.
Melanie: That’s an interesting statement. So, independent of their weight loss, their diabetic medications might be reduced, or even eliminated after bariatric surgery. How do they know? If they’ve had Type II diabetes – they’ve been diagnosed - and you’re discussing with them the options of bariatric surgery, what do you tell them that they should look for afterward to get tested?
Dr. Scott: Patients that meet the criteria for bariatric surgery and have Type II diabetes should be counseled by their primary care doctors to consider surgery as one of their treatment options for Type II diabetes. Surgery is certainly not for everybody and a patient and their surgeon have to review some of the risks and benefits for surgery before deciding to choose that pathway. However, a lot of patients don’t realize that there are surgical options for the treatment of Type II diabetes.
Melanie: Tell us a little bit about the surgical options, Dr. Scott, and what can they expect from bariatric surgery?
Dr. Scott: There are several bariatric operations that are performed around the country. At the Greenville Health System, we primarily perform two bariatric operations. The first bariatric operation is the laparoscopic Roux-en-Y divided gastric bypass. In that operation we make a smaller stomach for the patient so they can’t eat as much food and they can’t absorb as much calories and then we rearrange the intestines so that the food is processed differently. That rearrangement of the intestines definitely has impact on Type II diabetes. The second operation that we do is called the “laparoscopic vertical sleeve gastrectomy.” In this operation, we remove about 70% of the volume of the stomach and that makes a much smaller stomach and also decreases appetite. In addition, the laparoscopic sleeve gastrectomy also removes a hormone that is made in the stomach that can affect appetite.
Melanie: So, in the gastric bypass and the sleeve gastrectomy, are both of these permanent solutions? Are they permanent situations that cannot be reversed?
Dr. Scott: That’s right. The gastric bypass, although it can be reversed, it’s a very difficult operation to try to accomplish. These operations are meant to be permanent for the patient.
Melanie: Do you feel that this is gaining a little bit more ground? Because for a while, primary care physicians were a little reluctant to advise for bariatric surgery for their Type II or obese patients? What do you think is changing in the landscape now?
Dr. Scott: Certainly, the safety of the surgery has definitely improved over the past 30 years. As more technological advancements in surgery have come about; as more advanced training techniques have been applied and certain quality measurements like the quality improvement system that we use at the Greenville Health System--once these were implemented, the complication rates and the mortality rates after bariatric surgery dropped significantly. As it stands right now, bariatric surgery is one of the safer operations that you can have done. It is certainly safer than many cancer surgeries, definitely safer than even having your gall bladder taken out.
Melanie: It really is an amazing procedure that you doctors are doing and helping so, so many people. What can they expect from recovery? How fast can a bariatric patient whose has gone through this Roux-en-Y or the sleeve gastrectomy, how fast can they get back to living that normal life?
Dr. Scott: After every surgery, we want patients up and about the day of their surgery. Most of these operations are done through tiny laparoscopic incisions about the size of a fingernail and patients are up on their feet soon after surgery. We get them home within one to two days. We encourage them to begin an exercise program when they get home and start adjusting to their new diet and their new lifestyle. On average, most sleeve gastectromy patients recover fully within about one to two weeks and gastric bypass patients, it takes about three to four weeks to truly feel like themselves.
Melanie: How often do they monitor their blood sugar after this surgery? You said they can see a difference in a week or two. How often should they be monitoring their blood sugar after that if they are starting to decrease their medications? Is this something they still need to keep their eye on?
Dr. Scott: I encourage our patients to maintain their normal blood sugar routines for the first month after surgery. Certainly, the way that the blood sugar returns to a normal state differs in each patient. Some patients, their blood sugar levels will return to normal very quickly. In other patients, especially patients who have had diabetes for a longer period of time and are on multiple medications, may see that return to normal blood sugar levels usually within the first month. We work hand in hand with patients and their primary care doctors and their endocrinologists to make sure that their blood sugar levels are where they need to be and that we reduce the medications when they need to be reduced so that patient’s blood sugars don’t drop too low.
Melanie: What do you want them to know about diet and nutrition, aside from the sheer amounts if they’ve been created this small pouch, what do you want them to know about diet going forward and how you want them to get that good nutrition in while watching those blood sugar levels?
Dr. Scott: One of the benefits of our program here at the Greenville Health System is that we have two full-time dieticians that work within our office and two additional dieticians that work in our satellite offices that are also diabetic educators. We work hand in hand with our patients to not only address any blood sugar issues that they have prior to surgery and immediately after surgery but all of the bariatric diets that we have are designed to not have a dramatic impact on blood sugar levels. We certainly, as patients are adjusting to their new anatomy after bariatric surgery, all of our diets are heavy on protein and light on carbohydrates and that tends to help stabilize the blood sugar levels after surgery.
Melanie: In just the last minute, Dr. Scott, give us your best advice for those obese patients out there considering bariatric surgery and why they should come to Greenville Health System for their care.
Dr. Scott: We have been performing bariatric surgery in the Greenville Health System for almost 15 years. We have the most experience in the Southeast in dealing with bariatric surgery care. We have five bariatric surgeons that are on our staff and three offices where, pretty much, all we do is take care of bariatric patients. We just want patients to know that they have a choice. A lot of patients don’t understand that they have an opportunity to go into complete remission from their diabetes after bariatric surgery and making the necessary lifestyle changes that follow that. We want people to know that they have an option for getting rid of their diabetes.
Melanie: Such a fascinating topic and such great information. Thank you so much, Dr. John Scott. You're listening to Inside Health with Greenville Health System. For more information, you can go to GHS.org. That's GHS.org. This is Melanie Cole. Thanks for listening.
Melanie Cole (Host): If you are an obese person and you have been diagnosed with Type II diabetes, there are some very important reasons that you might want to consider bariatric surgery. My guest today is Dr. John Scott. He is a bariatric surgeon at Greenville Health System. Welcome to the show, Dr. Scott. Tell us a little bit about Type II diabetes as it relates to obesity and then we’ll get into bariatrics.
Dr. John Scott (Guest): Sure. Well, thank you for having me on. Type II diabetes runs hand in hand with morbid obesity. Your chances of becoming a Type II diabetic go up almost 30 times if you are obese as opposed to being a normal weight individual.
Melanie: Is this something that is easily dealt with? We hear about Type I diabetes and how difficult that is to titrate your insulin levels with your exercise and diet. But Type II, people say, is a lifestyle and sedentary behaviors. Is this something that is so difficult to control that that’s when a person needs to really consider interventions?
Dr. Scott: Certainly Type II diabetes is a chronic medical condition. Medical doctors that take care of patients with Type II diabetes are getting much better at managing the disease. As far as getting somebody to go into remission from that, bariatric surgery offers people an opportunity to get rid of their diabetes completely and get off medications. The ability to get rid of your diabetes is independent of weight loss. People, after they have bariatric surgery, their diabetes can go away within weeks to months even before a lot of weight loss takes place.
Melanie: That’s an interesting statement. So, independent of their weight loss, their diabetic medications might be reduced, or even eliminated after bariatric surgery. How do they know? If they’ve had Type II diabetes – they’ve been diagnosed - and you’re discussing with them the options of bariatric surgery, what do you tell them that they should look for afterward to get tested?
Dr. Scott: Patients that meet the criteria for bariatric surgery and have Type II diabetes should be counseled by their primary care doctors to consider surgery as one of their treatment options for Type II diabetes. Surgery is certainly not for everybody and a patient and their surgeon have to review some of the risks and benefits for surgery before deciding to choose that pathway. However, a lot of patients don’t realize that there are surgical options for the treatment of Type II diabetes.
Melanie: Tell us a little bit about the surgical options, Dr. Scott, and what can they expect from bariatric surgery?
Dr. Scott: There are several bariatric operations that are performed around the country. At the Greenville Health System, we primarily perform two bariatric operations. The first bariatric operation is the laparoscopic Roux-en-Y divided gastric bypass. In that operation we make a smaller stomach for the patient so they can’t eat as much food and they can’t absorb as much calories and then we rearrange the intestines so that the food is processed differently. That rearrangement of the intestines definitely has impact on Type II diabetes. The second operation that we do is called the “laparoscopic vertical sleeve gastrectomy.” In this operation, we remove about 70% of the volume of the stomach and that makes a much smaller stomach and also decreases appetite. In addition, the laparoscopic sleeve gastrectomy also removes a hormone that is made in the stomach that can affect appetite.
Melanie: So, in the gastric bypass and the sleeve gastrectomy, are both of these permanent solutions? Are they permanent situations that cannot be reversed?
Dr. Scott: That’s right. The gastric bypass, although it can be reversed, it’s a very difficult operation to try to accomplish. These operations are meant to be permanent for the patient.
Melanie: Do you feel that this is gaining a little bit more ground? Because for a while, primary care physicians were a little reluctant to advise for bariatric surgery for their Type II or obese patients? What do you think is changing in the landscape now?
Dr. Scott: Certainly, the safety of the surgery has definitely improved over the past 30 years. As more technological advancements in surgery have come about; as more advanced training techniques have been applied and certain quality measurements like the quality improvement system that we use at the Greenville Health System--once these were implemented, the complication rates and the mortality rates after bariatric surgery dropped significantly. As it stands right now, bariatric surgery is one of the safer operations that you can have done. It is certainly safer than many cancer surgeries, definitely safer than even having your gall bladder taken out.
Melanie: It really is an amazing procedure that you doctors are doing and helping so, so many people. What can they expect from recovery? How fast can a bariatric patient whose has gone through this Roux-en-Y or the sleeve gastrectomy, how fast can they get back to living that normal life?
Dr. Scott: After every surgery, we want patients up and about the day of their surgery. Most of these operations are done through tiny laparoscopic incisions about the size of a fingernail and patients are up on their feet soon after surgery. We get them home within one to two days. We encourage them to begin an exercise program when they get home and start adjusting to their new diet and their new lifestyle. On average, most sleeve gastectromy patients recover fully within about one to two weeks and gastric bypass patients, it takes about three to four weeks to truly feel like themselves.
Melanie: How often do they monitor their blood sugar after this surgery? You said they can see a difference in a week or two. How often should they be monitoring their blood sugar after that if they are starting to decrease their medications? Is this something they still need to keep their eye on?
Dr. Scott: I encourage our patients to maintain their normal blood sugar routines for the first month after surgery. Certainly, the way that the blood sugar returns to a normal state differs in each patient. Some patients, their blood sugar levels will return to normal very quickly. In other patients, especially patients who have had diabetes for a longer period of time and are on multiple medications, may see that return to normal blood sugar levels usually within the first month. We work hand in hand with patients and their primary care doctors and their endocrinologists to make sure that their blood sugar levels are where they need to be and that we reduce the medications when they need to be reduced so that patient’s blood sugars don’t drop too low.
Melanie: What do you want them to know about diet and nutrition, aside from the sheer amounts if they’ve been created this small pouch, what do you want them to know about diet going forward and how you want them to get that good nutrition in while watching those blood sugar levels?
Dr. Scott: One of the benefits of our program here at the Greenville Health System is that we have two full-time dieticians that work within our office and two additional dieticians that work in our satellite offices that are also diabetic educators. We work hand in hand with our patients to not only address any blood sugar issues that they have prior to surgery and immediately after surgery but all of the bariatric diets that we have are designed to not have a dramatic impact on blood sugar levels. We certainly, as patients are adjusting to their new anatomy after bariatric surgery, all of our diets are heavy on protein and light on carbohydrates and that tends to help stabilize the blood sugar levels after surgery.
Melanie: In just the last minute, Dr. Scott, give us your best advice for those obese patients out there considering bariatric surgery and why they should come to Greenville Health System for their care.
Dr. Scott: We have been performing bariatric surgery in the Greenville Health System for almost 15 years. We have the most experience in the Southeast in dealing with bariatric surgery care. We have five bariatric surgeons that are on our staff and three offices where, pretty much, all we do is take care of bariatric patients. We just want patients to know that they have a choice. A lot of patients don’t understand that they have an opportunity to go into complete remission from their diabetes after bariatric surgery and making the necessary lifestyle changes that follow that. We want people to know that they have an option for getting rid of their diabetes.
Melanie: Such a fascinating topic and such great information. Thank you so much, Dr. John Scott. You're listening to Inside Health with Greenville Health System. For more information, you can go to GHS.org. That's GHS.org. This is Melanie Cole. Thanks for listening.
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