Surgery for Diabetes
Did you know?
  • Diabetes is a leading cause of cardiovascular disease, blindness, amputation and kidney failure
  • There is an emerging global epidemic of diabetes: 347 million people worldwide have diabetes. The World Health Organization estimates that diabetes will become the 7th leading cause of death in the world by 2030
  • This diabetes epidemic can be traced back to rapid increases in overweight/obesity and physical inactivity
  • Approximately 90% of Type 2 diabetes mellitus (T2DM: the most common form of diabetes), is attributable to excessive body fat
  • Singapore has not been spared the twin epidemics of diabetes and obesity: obesity rates in Singapore increased by >50% between 1998 and 2010
  • Surgery (Metabolic & Bariatric Surgery) is the most effective treatment for T2DM among individuals who are affected by obesity and may result in remission or improvement in nearly all cases

Type 2 Diabetes Mellitus (T2DM)
Type 2 diabetes is the most common form of diabetes. Obesity is the primary causative factor for T2DM and the rise in diabetes prevalence globally is closely related to worldwide increasing rates of obesity. T2DM leads to many health problems including blindness, cardiovascular disease, stroke, peripheral vascular disease & amputations, neuropathy, impotence and kidney failure. T2DM is a major burden on healthcare systems in many countries.
Current treatment for T2DM includes lifestyle modification (diet, exercise & weight loss) and medication. Patients with T2DM must maintain blood sugar levels which are as close to normal as possible, in order to avoid developing diabetes complications. Even with medication, most diabetics are unable to keep their blood sugar levels in check. In a recent article in The Straits Times, a Singapore healthcare professional commented that ‘6 in 10 don’t meet their target’ ie. approximately 60% of diabetics in Singapore fail to meet treatment targets despite optimal medical care.
There is no doubt that all surgical procedures, including bariatric surgery, are associated with some risk. But for obese patients with T2DM, the long-term risk of continued & poorly controlled diabetes typically outweighs the risk of a surgical procedure.
T2DM and Metabolic/Bariatric Surgery
Metabolic & Bariatric surgery is now an accepted treatment option for a carefully selected population of obese diabetics. Nearly all obese diabetics show improvement in their diabetic state after weight loss surgery (currently termed Metabolic & Bariatric Surgery).
Bariatric surgery improves T2DM in 90% of patients by:
  • Lowering blood sugar
  • Reducing the dosage of medication required
  • Improving diabetes-related health problems
Bariatric surgery causes T2DM to go into remission in >75% of patients by:
  • Reducing blood sugar levels to normal levels
  • Eliminating the need for diabetes medications
The International Diabetes Federation (IDF) Position Statement on Weight Loss (Bariatric) Surgery in the Treatment of Type 2 Diabetes
In 2011, at the 2nd World Congress on Interventional Therapies for Type 2 Diabetes in New York City, diabetologists, surgeons and public health experts convened to discuss the role of surgery in the management of diabetes. Based on evidence presented by world-renowned experts, the IDF released a Position Statement calling for bariatric surgery to be considered early in the treatment of T2DM.
The IDF recognized that:
  • In addition to behavioural and medical treatments, bariatric surgeries constitute a powerful option to ameliorate diabetes in patients affected by severe obesity
  • Bariatric surgery is appropriate treatment for people with T2DM and obesity not achieving recommended treatment targets with medical therapies
  • Surgery is an accepted option in people who have T2DM and a BMI of 32.5 or more
  • Surgery should be considered as an alternative treatment option in patients with a BMI between 30 and 35 when T2DM cannot be adequately controlled by an optimal medical regimen, especially in the presence of other major cardiovascular disease risk factors (eg. hypertension, high cholesterol, etc)
  • Bariatric surgery for treatment of T2DM is cost-effective
  • The risk for complications and death with bariatric surgery is low and similar to that of well-accepted elective surgical procedures such as gallbladder surgery
Click to download a copy of the IDF position statement.
Types of Metabolic/Bariatric Surgery
At Bridge Bariatrics, T2DM patients who are obese and satisfy currently accepted eligibility criteriae (particularly those who fail to meet treatment targets or have coexisting major cardiovascular risk factors), are offered one of the following surgical options:
You may click on the links above for a brief description of these bariatric surgeries and how they work.