Goodbye, Diabetes

Often a surgical weight-loss procedure can actually reverse this metabolic condition, and the “duodenal switch” approach offers special promise.



Severely obese people suffering from diabetes can tackle both health conditions more effectively with a novel form of weight-loss surgery available at Saint Barnabas Medical Center.

Known as duodenal switch surgery, this technique is being performed by doctors at the Weight Loss Institute of New Jersey at Saint Barnabas Medical Center. Duodenal switch isn’t new, but is less commonly done worldwide than the gastric bypass or gastric sleeve surgical techniques for obesity.

More than 220,000 people undergo some type of weight-loss surgery each year in the United States, according to the American Society for Metabolic and Bariatric Surgery, and a rising incidence of extreme obesity is fueling a simultaneous rise in diabetes rates.

“It was a natural leap for me to start doing this procedure because it’s the best one for resolving diabetes,” explains Michael L. Bilof, M.D., section chief of the Bariatric Surgery Program at Barnabas Health. “Right now, duodenal switch is the most effective and best technique for diabetics.”

All bariatric surgeries work by either reducing stomach size or rerouting food from the stomach directly into the intestines so that the body absorbs less. Duodenal switch and gastric bypass combine both of these methods, but duodenal switch results in even less calorie absorption by aggressively bypassing most of the small intestine.

Any candidates for bariatric surgery— typically, people with a body mass index (BMI) of 35 or higher— are considered eligible for duodenal switch, Dr. Bilof says, but most of those to whom he highly recommends the procedure are morbidly obese patients with BMIs over 50 who also have diabetes.

“These patients could have one of the other procedures, but if their BMI is over 50 or 55, their long-term success is best with duodenal switch surgery,” says the doctor.

“The diabetes resolution rate with duodenal switch is 98 percent, and it remains over 90 percent in the long term.” —Michael Bilof, M.D.

Dr. Bilof minimizes potential complications from duodenal switch surgery—which include infection, blood loss and hernia development—by performing the technique laparoscopically through several small incisions in the abdomen. Open surgery that creates long incisions tends to have higher complication rates, he says.

All Saint Barnabas patients who have undergone duodenal switch over the past several months had two-day hospital stays—similar to other forms of bariatric surgery—and also were prescribed a similar post-operative diet that helped them make the transition over several weeks from liquids to purees to solid foods.

“So far, the duodenal switch patients we’ve done have been fully recovered and back to work in three to four weeks—the same as the time required with gastric bypass surgery,” Dr. Bilof says.

In addition to the expectation of significant weight loss, many duodenal switch patients leave the operating room with their blood sugar levels already returning to normal—a health benefit that’s in addition to eventual improvements in blood pressure, sleep apnea and cholesterol, he says. Scientists aren’t yet sure why duodenal switch and other bariatric procedures can cure diabetes, but it may involve the way blood sugar is metabolized or absorbed.

“We don’t know the exact mechanism,” he explains, “but the diabetes resolution rate with duodenal switch is 98 percent, and it remains over 90 percent in the long term.”

Increasing numbers of people are attending information sessions on duodenal switch surgery that are held at the Weight Loss Institute of New Jersey at Barnabas Health, bariatric navigator Jennifer Stein notes. Partially fueling this growing interest, Dr. Bilof says, is that many people who are candidates for the procedure have observed the ravages of diabetes— including kidney failure, blindness or limb amputations—in loved ones with the disease and desperately want to avoid having the same complications themselves.

“They say, ‘I want to make sure that doesn’t happen to me,’” he says. “It’s a wake-up call for them because this procedure isn’t just treating diabetes, it’s curing it.”

Aside from the many medical benefits, patients report back to Barnabas Health staff members that their overall quality of life is much enhanced by weight-loss surgery.

“Patients may be impressed that they can play with their kids or grandkids or sit in a regular-size seat at the theater or on a plane,” Dr. Bilof says. “They also don’t have as much back or joint pain and can easily walk or ride a bike. It’s hard to measure those things, but they matter to patients a lot.” —D.L.

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