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Obesity Surgery Can Put Type 2 Diabetes In Remission

Posted on: Thursday, 2 June 2005, 09:00 CDT

OBESITY SURGERY is an increasingly popular weight-loss method. Several kinds of surgeries exist; all reduce the size of the stomach so that it holds much less food. Some surgeries also keep the body from absorbing food well. As a result, the person takes in fewer calories and loses weight.

People with type 2 diabetes get an important additional benefit, a review has found. Blood glucose levels return to normal in three- quarters of people with type 2 diabetes who have obesity surgery.

The goal of the review, which was published in the Oct. 13, 2004, issue of the Journal of the American Medical Association, was to examine past studies of obesity surgery to determine its effects on four obesity-related conditions: type 2 diabetes, high blood pressure, lipid abnormalities (such as high cholesterol), and obstructive sleep apnea (a condition in which people wake repeatedly during the night because they stop breathing).

The researchers searched several electronic databases for studies of obesity surgery that included 10 or more people and followed them for 30 days or more. To be included in the analysis, studies had to contain information on at least one of the four obesity-related conditions. After several stages of winnowing, 136 studies that had included 22,094 people remained. Only five studies were randomized controlled trials, the most rigorous kind of study. The researchers then performed a metaanalysis, which means they combined similar data from different studies to create, in effect, one gigantic study.

The researchers looked at each medical condition to see whether it improved or resolved after stomach surgery. "Resolved" meant the condition disappeared or no longer required treatment. The researchers considered diabetes "resolved" if the person was able to stop all diabetes medicines and still have normal blood glucose levels.

The researchers found that overall, people who had obesity surgery lost an average of 61.2 percent of their excess weight. Different kinds of surgery produced different amounts of weight loss, but no method included in the study produced an average excess weight loss of less than 47.5 percent.

In studies that reported on people whose type 2 was resolved, 76.8 percent (of 1,846 people) experienced resolution of their disease. In studies that reported improvement results, more than 85 percent (of 485 people) saw improvement or resolution of their type 2 diabetes.

Researchers were able to narrow down type 2 resolution rates for specific kinds of stomach surgery. Among those who received gastric banding, 47.8 percent experienced resolution. The resolution rate was 68.2 percent for those who received gastroplasty; 83.8 percent for those who received gastric bypass (such as Roux-en-Y); and 97.9 percent for those who received biliopancreatic diversion and duodenal switch procedures. Improvement rates also varied, but were never less than 80 percent.

Cholesterol levels, triglyceride levels, blood pressure, and sleep apnea improved significantly as well, with at least three- quarters of the participants seeing benefits. As with diabetes, improvement rates varied among different methods.

The researchers concluded that stomach surgery in obese people reverses, eliminates, or substantially improves several obesity- related conditions, including diabetes. Only about 15 percent of people with diabetes saw no improvement in their blood glucose levels. Often, people's blood glucose levels returned to normal within a few days of surgery and stayed there. The researchers expect that these changes should markedly increase the life expectancy of many of the study's participants.

Choosing to have stomach surgery is a drastic step that deserves careful thought and detailed research into surgeons and techniques. It's painful and can have complications, and some insurance companies do not cover it. One's diet is forever limited. However, it is the most effective treatment known for type 2 diabetes and can help with other conditions such as high blood pressure that many people with diabetes have.

Only about 15 percent of people with diabetes saw no improvement in their blood glucose levels.

Shauna S. Roberts, PhD, is a science writer from New Orleans, La.

Copyright American Diabetes Association Jun 2005

Source: Diabetes Forecast

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