Bariatric Surgery May Work Better for Diabetics than Medical Care

Drastic “stomach stapling” surgery may be the only answer for some diabetics who find they simply cannot lose weight and improve their condition any other way.  Two new studies have found that bariatric operations were better at helping these people than more traditional approaches to treating the disease.

With obesity and morbid obesity on the rise in the US and other western countries, bariatric surgery is becoming more common.  Some surgeons specialize in it and do little else, operating on obese patients with a BMI of 40 and above who have been unable to lose weight by traditional methods.  Some 200,000 of these operations are carried out in theUSalone every year.

The surgery is also used on patients with a BMI of only 35 who have type 2 diabetes.  While there are significant risks associated with this type of operation, especially when performed on seriously overweight people, it may often be the only way of saving the patient’s life.

Several different types of surgery are used to decrease the gastric surfaces and thus the absorption of food calories, as well as simply reducing the capacity of the stomach so the patient cannot overeat.  Common forms involve fitting a gastric band to confine the stomach or actually isolating the greater part of the organ and creating a tiny stomach pouch that cannot accept more than a small amount of food.  Weight loss is usually swift and spectacular; in fact, many patients are obliged to return later for cosmetic surgery to remove loose skin.

The benefits of bariatric surgery include lowered cholesterol, blood pressure, and reduced danger from heart disease and cancer.  However, more importantly for diabetics it can cause a remission in the disease or at least reduce symptoms and need for medications significantly.  For some diabetics whose blood sugar levels are out of control, it may be the only way to save them from serious side effects of the disease, or even save their lives.

Two studies published in the New England Journal of Medicine confirmed observations by surgeons and doctors over many years that surgery often leads to a “cure” in diabetic patients.  The studies, carried out at the Cleveland Clinic in theUS and at theCatholicUniversity inRome, compared two types of weight reducing surgery and their effects on the disease with traditional medical treatment.  Medical treatment for type 2 diabetes includes careful dietary control, increased exercise, weight loss through diet, blood testing, and medication with preparations such as metformin or even insulin.

In the Roman study, 60 patients were given a gastric bypass, biliopancreatic diversion or traditional medical treatment. The results were spectacular, with 75% and 95% of the patients in the two surgery groups achieving total remission of their diabetes in two years.  The control group, who were given medical treatment only, had no remissions.

In the American study, the results were less impressive, largely because the researchers used a tighter definition of remission, with 42% and 37% for the two kinds of surgery.  The 150 subjects were divided into groups, which were given a gastric bypass operation, a sleeve gastrectomy, or medical treatment.  This study found 12% of the control group also achieved remission using intensive medical treatment.

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