By Natasha Persaud
Short of a cure, the holy grail of treating type 2 diabetes is remission: achieving normal glucose control without the need for diabetes medications. Now two studies from the New England Journal of Medicine have found that more people achieved glucose control and possibly remission with weight loss surgery than with medical treatment alone.
What did the first study show?
In an Italian study, sixty obese people with a body mass index (BMI) of 35 or more took diabetes medications or had weight loss surgery: Roux-en-Y gastric bypass or biliopancreatic diversion. In gastric bypass, a part of the stomach is sectioned off to make a small pouch for food and then attached directly to the small intestine. Biliopancreatic diversion removes a large part of the stomach and also bypasses a part of the small intestine.
After two years, no one on drug therapy achieved diabetes remission. But a majority of surgery patients did: 75 percent in the gastric bypass group and 95 percent in the biliopancreatic diversion group. Their average blood glucose (A1C levels) fell to 5 or 6 percent - within the recommended range of below 7 percent. Maintaining glucose levels within this range reduces the chances of some diabetes complications, such as retinopathy, kidney damage and nerve problems.
What did the second study show?
In an American study, weight loss surgery was compared to intensive medical therapy that included treatment with the latest diabetes drugs, weight management and frequent glucose monitoring at home. This time, all 150 overweight and obese participants received intensive therapy. Some also went on to have gastric bypass surgery or another weight loss surgery called sleeve gastrectomy. In sleeve gastrectomy, most of the stomach is removed and its new shape resembles a shirt sleeve.
The results: 12 percent of people who received medical therapy alone achieved an A1C of 6 percent or less. But a greater percentage of surgery patients also experienced this level of glucose control: 42 percent in the gastric bypass group and 37 percent in the sleeve gastrectomy group.
Weight loss may not be the only reason participants achieved remission. In fact, many enjoyed this level of glucose control before reaching their goal weight. Hormonal changes due to the re-arrangement of the intestines could be responsible for some of the success, suggests The Endocrine Society.
So, Is Weight Loss Surgery the Answer for All Obese People with Diabetes?
"[N]ot yet," according to the authors of an editorial accompanying the studies. While some participants achieved diabetes remission, it remains to be seen how long glucose control will last.
In addition, surgery is not without hazards. Some possible surgical complications include iron deficiency and anemia, other vitamin deficiencies, anastomatic leak, ulcer, stricture and fistula, and hernia.
Plus, researchers need to find answers to this outstanding question: Is weight loss surgery appropriate for all overweight people with diabetes? Right now, surgery is allowable for people with diabetes with a BMI of 35 or greater.
Should I Consider Weight Loss Surgery?
The Endocrine Society recommends that medical professionals consider a number of factors when recommending weight loss surgery for people with type 2 diabetes:
- BMI (To calculate your BMI, multiply your weight by 703, divide by your height in inches, then divide again by your height in inches.)
- number of years with diabetes
- willingness to make the long-term lifestyle changes that accompany weight loss surgery
If you're interested in weight loss surgery, talk to your doctor.
In summary, future research may reveal the full potential as well as limitations of weight loss surgery for diabetes. For now, the good news is weight loss surgery may be another arrow in the quiver.
News release: Evaluating the Benefits of Treating Type 2 Diabetes with Bariatric Surgery. The Endocrine Society. March 2012.
Mingrone, et al. Bariatric Surgery versus Conventional Medical Therapy for Type 2 Diabetes. New England Journal of Medicine. Published online March 26, 2012.
Schauer, et al. Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes. New England Journal of Medicine. Published online March 26, 2012.
Zimmet and Alberti. Editorial: Surgery or Medical Therapy for Obese Patients with Type 2 Diabetes? New England Journal of Medicine. Published online March 26, 2012.