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Obesity Surgery Tops Treatments for Diabetes

Posted on: Wednesday, 23 January 2008, 09:00 CST

Weight-loss surgery works much better than standard medical therapy as a treatment for Type 2 diabetes in obese people, the first study to compare the two approaches has found.

The study, of 60 patients, showed that 73 percent of those who had surgery had complete remissions of diabetes, meaning all signs of the disease went away. By contrast, the remission rate was only 13 percent in those given conventional treatment, which included intensive counseling on diet and exercise for weight loss, and, when needed, diabetes medicines like insulin, metformin and other drugs.

In the study, the surgery worked better because patients who had it lost much more weight than the medically treated group did - 20.7 percent versus 1.7 percent of their body weight, on average.

Type 2 diabetes is usually brought on by obesity, and patients can often lessen the severity of the disease, or even get rid of it entirely, by losing about 10 percent of their body weight. Though many people can lose that much weight, few can keep it off without surgery. (Type 1 diabetes, a much less common form of the disease, involves the immune system and is not linked to obesity.)

However, the new results probably do not apply to all patients with Type 2 diabetes, because the people in the study had fairly mild cases with a recent onset; all had received the diagnosis within the previous two years. In people who have more severe and long-standing diabetes, the disease may no longer be reversible, no matter how much weight is lost.

The operation used in the study, adjustable gastric banding, is performed through small slits and loops a band around the top of the stomach to cinch it into a small pouch so that people eat less and yet feel full. Other weight-loss operations are more extreme and involve cutting or stapling the stomach and rearranging the small intestine. Of the 205,000 weight-loss operations performed in the United States last year, 25 percent to 30 percent used the gastric banding.

The death rate for stomach band surgery, which can cost $17,000 to $20,000, is about 1 in 1,000. There were only minor complications in the study. Stomach stapling has a death rate of about 20 in 1,000 and costs $20,000 to $30,000.

Remission of Type 2 diabetes after weight-loss surgery is not a new finding; doctors have known about it for years. But the new research is the first attempt to find out scientifically how the surgery measures up against medical treatment in similar groups of patients with the disease.

The study reflects a growing interest among researchers in using surgery specifically to treat Type 2 diabetes, even in people who are not as obese as those who typically undergo operations to lose weight. The new thrust is in some sense a measure of desperation, as the United States and the world face increasing rates of the disease and its complications, which can include heart attacks, blindness, kidney failure and amputation. To many doctors, the time is ripe for studying surgery as a potential cure for diabetes, and also as way to understand the disease better and develop better drugs to treat it.

Medical societies in the United States and abroad that once called their specialty "bariatric" surgery, a term that refers to weight loss, have started adding the word "metabolic" to their titles to emphasize the new focus on diabetes.

"I think diabetes surgery will become common within the next few years," said Dr. John Dixon, the lead author of the study and an obesity researcher at Monash University in Melbourne, Australia, where the research was conducted.

The study and an editorial about it are being published today in The Journal of the American Medical Association.

The editorial, by doctors not involved in the study, said, "The insights already beginning to be gained by studying surgical interventions for diabetes may be the most profound since the discovery of insulin."

A researcher who is not a surgeon and was not part of the research, Dr. Rudolph L. Leibel, co-director of the Naomi Berrie Diabetes Center at Columbia University Medical Center, said the study was important because it showed that a minimally invasive type of surgery could reverse diabetes.

"At this point," Leibel said, "maybe we should be more accepting or responsive to the idea of surgical intervention for reducing or prevention of diabetes and its complications."

But at the same time, he said, caution was in order, because the study lasted only two years and it would be essential to find out how these patients fare over time.

About 19 million people in the United States have Type 2 diabetes, and an additional 54 million are "prediabetic," meaning they have abnormalities in their blood sugar that increases their risk for the disease, according to the American Diabetes Association. Diabetes is the fifth-leading cause of death by disease in this country, killing about 73,000 people a year.

The number of cases in the United States is growing by about 8 percent a year, according to the association. Though treatable, the disease is not curable, and it is often poorly controlled.

Source: Virginian - Pilot

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