Type 2 diabetes is a complex, demanding disease; just ask any of the 30 million folks in the U.S. contending with it daily. As insulin resistance increases and blood glucose becomes harder and harder to manage, it’s necessary to pay almost constant attention to activity levels, diet and other lifestyle habits that can make or break one’s attempt to regain control.

That’s not easy. Fewer than half of folks with Type 2 diabetes are able to establish tight glucose control, despite the use of medications and lifestyle changes. That means they’re at serious risk for the cascade of complications that result from unstable and elevated blood glucose levels.

Everything from cardiovascular disease and ketoacidosis to kidney and nerve damage, blindness, gastrointestinal distress, depression, chronic wound infections, hearing loss, gum disease and dementia is associated with Type 2 diabetes.

YOUR CHOICES

>> Medications: There have been significant advances in medications to manage both diabetes and heart disease (statins and antihypertensives), as well as new classes of diabetes drugs (DPP-4 inhibitors, GLP-1-receptor agonists and SGLT2 inhibitors), such as Januvia, Ozempic and Farxiga, that help manage glucose levels as well as kidney and liver problems and heart failure in order to extend lives. They are often used in combination with basic medications such as metformin or, in more advanced cases, with insulin.

>> Lifestyle: Nondrug approaches have also gotten more effective, and we know how to prevent the onset in high-risk people and even reverse the disease with aggressive lifestyle changes in the early years after onset. The DiRECT trial showed that within six years of diagnosis, by losing about 33 pounds on a low-calorie diet, 86% of folks with Type 2 will no longer have the disease a year later.

WHAT ELSE?

Unfortunately, there are still far too many people experiencing the devastating complications of Type 2 diabetes. Almost 7 in 10 people with diabetes over age 65 will die of some type of heart disease. About 1 in 6 will die of stroke. And 247,000 people are currently living with kidney failure resulting from diabetes. According to experts at Dr. Mike’s Cleveland Clinic, that’s where gastrointestinal surgery comes into the picture. It is the most powerful remedy for people who are obese, have Type 2 diabetes and are headed toward the life-altering complications it triggers.

The problem is people don’t see it as a viable option. It is surgery, after all, and post-surgery you have to have a lifelong (and your life will be longer) commitment to change your eating and activity habits and maintain your weight loss. But bariatric surgeon Dr. Ali Aminian and his research team at the Department of Quantitative Health Sciences in the Lerner Research Institute want everyone to know that there are a lot of studies that show how effectively gastric surgery restores healthy glucose levels and leads to remission that endures! No more diabetes, no more meds and no complications.

In fact, their team published two studies in JAMA that showed people with obesity and Type 2 diabetes who had the weight-loss gastro­surgery achieved a 40% lower risk of death and had far fewer major cardiovascular events over a 10-year period than folks who were getting standard medical care for the disease.

MAKING THE DECISION

To help people decide whether they should opt for gastrointestinal weight-loss surgery, the researchers developed a calculator that can estimate your 10-year risk of developing diabetes-related complications. It lets you know how those risks will be reduced or eliminated if you opt for the surgery. You can use the calculator at riskcalc.org/Bariatric SurgeryComplications.

So, take a look at your risks and at how much surgery could benefit you. Then talk with your endocrinologist about what you’ve learned. (You do have an endocrinologist, who specializes in Type 2 diabetes, don’t you?) Figure out together your best treatment option for a longer and healthier future.

Mehmet Oz, M.D., is host of “The Dr. Oz Show,” and Mike Roizen, M.D., is chief wellness officer and chairman of the Wellness Institute at Cleveland Clinic. Email questions to youdocsdaily@sharecare.com.