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Management of obese/overweight diabetic adults begins with lifestyle changes consisting of diet, physical activity, medications and behavioural strategies. These can lead to improvement or remission but T2DM often progresses and worsens with time. Weight loss medications can considered but must be balanced against potential risks.
Studies have shown that weight loss surgery performed on diabetic adults lowers blood sugar levels, decreases or eliminate diabetic medications and improves diabetes related conditions. These effects have been shown to last for years.
Diabetes Australia have advised that weight loss surgery is an effective treatment option for adults with Type 2 Diabetes and a BMI over 35, in whom medical treatment has been unsuccessful. This advice is in line with the UK National Institute for Clinical Excellence (NICE), American Diabetes Association (ADA) and International Diabetes Foundation (IDF) guidelines.
The advantages of surgery are near or complete normalization of blood sugar levels. Research has shown that the best predictors of diabetes remission following surgery are a low baseline glucose level (better controlled diabetes), younger age and shorter diabetes duration. This emphasizes the advantage of an early operation in appropriate adults.
Furthermore, weight loss in obese adults has also been shown to delay the progression of prediabetes to Type 2 diabetes.
All weight loss surgery must be performed within accepted guidelines and supported by multidisciplinary care, patient education and follow up.