Though lifestyle interventions along with medical treatment options are initial line of treatment for any diabetic patient, but they have very limited success in controlling blood glucose levels amongst the severely obese, with many of these patients not achieving targets.
There is strong evidence that significant weight loss achieved by using lifestyle and medical methods by obese, particularly severely obese, people is modest and rarely sustained, particularly in the severely obese.
A number of these medications used for treating Type 2 diabetes, including insulin, themselves can result in weight gain.
Almost all severely obese patients are unsuccessful in their efforts to achieve sustained and significant weight loss and there is evidence that weight loss induced by Gastro-intestinal (bariatric) surgery can lead to remission of “high blood sugar” in the majority of patients with diabetes. Earlier treatment increases the likelihood of remission. In the remaining patients, residual hyper-glycaemia is easier to manage following surgery. It can therefore be suggested that Gastro-intestinal (bariatric) surgery for the morbidly (severely) obese with Type 2 diabetes should be considered early as an option for eligible patients, rather than being held back as a last resort.
In addition to weight loss by Gastro-intestinal (Bariatric) surgery, has been shown to substantially improve hypertension, high cholesterol and sleep apnoea and several reports have documented an improvement of overall survival and specific reduction in diabetes-related mortality.