Type 2 diabetes is strongly associated with obesity. Because of this, it’s common for obese diabetics to visit my clinic and ask, “Can the sleeve gastrectomy cure my type 2 diabetes?” Based on my experience as a bariatric surgeon and my research into the available scientific literature, I often answer this question “yes.”

However, the idea of curing diabetes with a sleeve gastrectomy is a bit more complicated than a simple yes or no. In this article, I’ll explain what is medically required for a patient to be deemed “cured” of diabetes, as well as why I consider sleeve gastrectomy to be an effective treatment—and, sometimes, cure—for type 2 diabetes.

What is Type 2 Diabetes?

Type 2 diabetes is a chronic disease that affects the lives of millions of people worldwide. It is a metabolic illness in which the body cannot manufacture sufficient insulin to fulfill its own requirements. Type 2 diabetes is characterized by high blood sugar levels, which can result in a variety of severe health complications, including heart disease, blindness, and kidney failure.

Although we don’t know the specific causes of type 2 diabetes, we are aware of various risk factors, including obesity, age, a sedentary lifestyle, and a poor diet. It appears that the path to diabetes starts with the cells in the body not responding well to the signal insulin gives it to allow for sugar to be drawn into the cell and out of circulation. This is known as insulin resistance.

In order for the cell to react, an ever-increasing quantity of insulin is necessary as the illness advances. Over time, the pancreas is unable to produce sufficient insulin to overcome resistance. When this occurs, sugar levels in the bloodstream begin to rise, resulting in high blood sugar levels.

What is a Sleeve Gastrectomy?

A sleeve gastrectomy is a form of weight reduction surgery in which a piece of the stomach is removed to create a smaller, sleeve-shaped stomach. Essentially, the stomach is transformed from a large sack into an organ shaped like a banana.

A sleeve gastrectomy causes weight loss and disease resolution in two primary ways:

• Because of the smaller size of the stomach, the amount of food that can be eaten is reduced.
• Changes in gastrointestinal hormones allow the body to process food in a more normal fashion and allocate food in a healthier way.

Read more about the benefits of sleeve gastrectomies here.

Can Type 2 Diabetes be Cured with Sleeve Gastrectomy?

The short answer is yes, in my opinion. Let me give you a real-world example.

Scott is a 58-year-old male who weighed 410 pounds when we first met in May of 2021, having already suffered a heart attack several years prior. Looking at his health record, it wasn’t hard to see why. Scott’s diabetes necessitated 100 units of insulin a day through his insulin pump. But even the insulin pump couldn’t keep his diabetes under tight control, because his HbA1c would routinely exceed 9.

In addition to type 2 diabetes, Scott also had hypertension and sleep apnea. His genetics were also working against him, with a father and several grandparents that had suffered from heart disease.

Scott was a ticking time bomb. After his cardiologist and nurse practitioner recommended bariatric surgery, he came to my office requesting assistance.

Scott had a sleeve gastrectomy in January of 2022. Since then, he has lost over 100 pounds. He has gone from a 50” waist to a 42” waist. He is off all of his hypertensive medications. His sleep apnea has vastly improved. The most exciting improvement is the response his blood sugars have had to the procedure: he is off all his diabetes medications, his HbA1c is now 5, and his continuous glucose monitor runs from 80 to 100.

While Scott loves the fact that his insulin pump is in a drawer, it’s the quality-of-life improvements that bring a smile to his face. For instance, he can tie his own shoes. His wife can wrap her arms all the way around him for an extra-big hug. His energy is back, and he’s more involved in his life. Plus, he’s looking forward to go-carting with his grandson.

This is the kind of transformation that makes me love my job!

Scott’s story, while impressive, is not unusual. But is he cured of his diabetes? It depends on who you ask.

I would say that we need to wait and see what happens. Because Scott is off all diabetes medications and has a normal A1c, I would say he is in remission. If he goes back on his medication or his A1c bumps, I would say that his diabetes has recurred. If he stays off his meds with a normal A1c for 5 years, I would say he is cured, but purists would argue that he is in long-term remission. Even if he lives to be 150 years old and never gets back on his medications, some would argue he was never cured but in “permanent remission.”

I don’t want to argue semantics. In my mind, if you stay off all meds and your A1c is normal for 5 years, you’re cured.

What Does Science Say About Sleeve Gastrectomy Curing Type 2 Diabetes?

I often get excited when seeing type 2 diabetic patients because I know that they can make great strides in their health. And it’s not just me who holds this belief, either—the scientific literature is full of information on how bariatric surgery provides a cure for diabetes.

Some of the following data isn’t specific to the sleeve, but it does lay the groundwork for the robust amount of data in the literature that concerns how bariatric surgery and the sleeve gastrectomy can provide a cure for type 2 diabetes.

Annals of Surgery, 1992: Is Type 2 Diabetes Mellitus A Surgical Disease?

Dr. Walter Pories documented 515 consecutive gastric bypass patients over an 11-year period. He showed a nearly 90% resolution of diabetes in this cohort of patients. Dr. Pories noted that diets don’t work in the morbidly obese, and that “the general course of their illness is a pattern of ever-increasing weight, worsening diabetes, and progression of diabetic complications.” He concluded that the gastric bypass is an effective treatment for morbidly obese diabetics.

JAMA, 2004: Bariatric Surgery: A Systematic Review & Meta-Analysis

Dr. Henry Buchwald looked at over 136 studies involving over 22,000 patients and concluded that 83.7% of diabetic patients were cured by gastric bypass surgery.

New England Journal of Medicine, 2012: Bariatric Surgery & Prevention of Type 2 Diabetes in Swedish Obese Subjects

The Swedish Obesity Subjects study was a significant prospective cohort investigation. 2,000 people who had bariatric surgery were contrasted with another 2,000 people who had not had the procedure. The result was a treasure trove of knowledge for the academic community. Bariatric surgery was shown to lower the risk of developing type 2 diabetes in obese patients by 78%.

Annals of Surgery, 2013: Can Diabetes Be Surgically Cured?

Dr. Stacy Brethauer conducted a study on 217 patients with type 2 diabetes six years after they underwent bariatric therapy. He reported that after five years or longer, 84% of diabetes patients had been cured or significantly improved. Dr. Brethauer also noticed that following their procedure, 50% of patients were completely off of all diabetes medications for at least five years.

Diabetes Care, 2016: Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes

In 2016, professional organizations from around the world that specialize in the treatment of diabetes—such as the American Diabetes Association (ADA)—came together and published a unified statement that was supported by approximately 50 medical and surgical associations. In this statement, a new algorithm for the treatment of diabetes was revealed, stating that a patient with type 2 diabetes and a BMI greater than 40 should be recommended surgery. Shortly after the publication of this joint statement, the ADA included their endorsement of the standards in their document titled “Standards for Medical Care in Diabetes.”

New England Journal of Medicine, 2017: Bariatric Surgery vs. Intensive Medical Therapy for Diabetes

The STAMPEDE experiment is a three-arm randomized controlled trial that monitored the outcomes of 150 type 2 diabetes patients following intensive medical treatment (IMT), IMT plus Roux-en-Y gastric bypass, or IMT with sleeve gastrectomy. After a follow-up period of five years, the clinical trial was published with the conclusion that bariatric surgery was superior to IMT in terms of glycemic control, weight loss, reduction in the amount of medication required, improvement in lipid levels, and enhancement in quality of life.

There are hundreds of additional studies looking at every patient variable imaginable and every possible outcome. Bariatric surgery (and the sleeve gastrectomy specifically) has been shown to be a great solution for people suffering from diabetes. If you qualify and if you are medically stable enough for surgery, you owe it to yourself to consider sleeve gastrectomy as a potential solution for you.

Talk to Your Doctor About Sleeve Gastrectomy for Diabetes

Sleeve gastrectomy is an excellent treatment option for obese individuals with type 2 diabetes. Current research indicates that sleeve gastrectomy can result in considerable weight loss, as well as an improvement—or possibly even a cure—for type 2 diabetes. The associated advantages may include better glucose control, less insulin resistance, and a decreased need for diabetic drugs.

To find out if sleeve gastrectomy is appropriate for you, you’ll need to discuss the risks and restrictions of the procedure with your primary care physician (PCP) and a bariatric surgeon. If you are considering sleeve gastrectomy, the professionals at the Bariatric and Metabolic Institute—such as myself!—would love to help you on your journey to better health and a more fulfilling life.

I am a highly experienced board-certified bariatric surgeon at Arkansas Heart Hospital’s Encore Medical Center in Bryant. I encourage you to contact me by calling (501) 219-7770 so we can explore your options together.