March 27, 2012
Bariatric Surgery Best Option For Treating Type 2 Diabetes
A new study, the first of its kind, shows bariatric surgery dramatically outperforms standard medical practices when treating Type 2 diabetes.
Researchers from the Catholic University/Policlinico Gemelli in Rome, Italy, and NewYork-Presbyterian/Weill Cornell Medical Center conducted the study and published their findings Monday in an advanced online edition of the New England Journal Medicine (NEJM).
The study reports a majority of the patients who received bariatric surgery were all to discontinue all diabetes medications and after two years remained disease free. Those in the study who were randomly selected to receive standard medical treatment did not experience the same dramatic results.
“Although bariatric surgery was initially conceived as a treatment for weight loss, it is now clear that surgery is an excellent approach for the treatment of diabetes and metabolic disease,” says senior author Dr. Francesco Rubino, chief of Gastrointestinal Metabolic Surgery and director of the Metabolic and Diabetes Surgery Center at NewYork-Presbyterian/Weill Cornell and associate professor of surgery at Weill Cornell Medical College.
Treating obese patients with Type 2 diabetes can be quite challenging, as most insulin therapy and hypoglycemic medications can cause weight gain. Rather than experience this kind of weight gain, those patients selected in this new study to undergo bariatric surgery showed improvements in blood sugar levels, as well as decreased total cholesterol and triglycerides. These results suggest bariatric surgery may greatly reduce a patient´s risk of a cardiovascular event.
“The unique ability of surgery to improve blood sugar levels and cholesterol levels as well as reduce weight makes it an ideal approach for obese patients with type 2 diabetes,” says lead author Dr. Geltrude Mingrone, chief of the Division of Obesity and Metabolic Diseases and professor of medicine at Catholic University in Rome.
According to a press release announcing the new findings, the study was completely randomized and included patients aged 30 to 60.
60 severely obese patients with advanced diabetes were evaluated in the study. These patients were randomly assigned to one of three groups: one group received Roux-en-Y gastric bypass (RYGB); the second group received a bilopancreatic diversion (BPD); and the third group underwent traditional, individualized medication and a strictly monitored dietary and lifestyle change.
None of the 60 patients who underwent traditional medical treatment and changed their diet and lifestyle have gone into remission. By contrast, 75% of those who received RYGB and 95% of those who underwent BPD went into remission. Remission is described in this study as fasting glucose of less than 100 mg and hemoglobin A1c of less than 6.5% for at least one year.
“These findings confirm that the effects of bariatric surgery on type 2 diabetes may be attributed to the mechanisms of surgery rather than the consequences of weight loss,” says Dr. Mingrone. “Studying the actual mechanisms by which surgery improves diabetes may help understand the disease better” she adds.
While effective, bariatric surgery remains costly and out of reach for many patients worldwide. The researchers hope their new findings will help change the way bariatric surgery is perceived and therefore more likely to be considered by physicians as a treatment of diabetes.