Bariatric Surgery on Diabetics May Be Better Than Standard Treatment

March 26, 2012
Surgery on Diabetics May Be Better Than Standard Treatment
By DENISE GRADY - New York Times

For some people with diabetes, surgery may be the best medicine.

Two studies have found that weight loss operations worked much better than the standard treatments to control Type 2 diabetes in obese and overweight people. Those who had surgery to staple the stomach and reroute the small intestine were much more likely to have their diabetes go into complete remission, or to need less medicine, than people given the typical regimen of drugs, diet and exercise, the studies found. The surgery also helped many to lower their blood pressure and cholesterol.

The new studies, published online on Monday by The New England Journal of Medicine, are among the first to to rigorously compare surgery and medicine as ways to control diabetes. Doctors have noticed for years that weight loss operations, also called bariatric surgery, sometimes get rid of Type 2 diabetes.

Better treatments are desperately needed for Type 2 diabetes, experts say. In the United States, the number of diabetes cases has tripled in the past 30 years and now numbers more than 20 million, according to the Centers for Disease Control and Prevention. Most of the cases are Type 2. The disease is also becoming more common in much of the world, with devastating complications like heart disease, blindness, amputations and kidney failure.

Type 2 diabetes, which causes high blood sugar and is linked to obesity, often becomes harder to manage as it progresses . Type 1, far less common, involves the immune system and is not linked to obesity.

The studies are part of a push by surgeons and obesity experts to establish a role for the operations in treating diabetes, not just obesity. Many surgeons now call the operations “metabolic” surgery to emphasize that they can affect more than weight.

One of the new studies, conducted at the Catholic University in Rome, looked at two types of bariatric surgery and compared them with medical treatment. After two years, the surgical groups had complete remission rates of 75 percent and 95 percent; there were no remissions in patients who received medical treatment.

The second study, at the Cleveland Clinic, also compared two types of surgery with an intensive medical regimen. The remission rates one year after surgery were lower than in the Italian study — 42 percent and 37 percent — at least in part because the American study used a stricter definition of remission. The intensive medical treatment led to remissions in 12 percent of patients.

Heather Britton, 53, a computer programmer who lives in Bay Village, Ohio, a suburb of Cleveland, participated in the Cleveland study, and for her, it seemed to come in the nick of time. Ms Britton had been diabetic for five or six years and was taking two diabetes drugs, but her blood sugar was out of control and so were her cholesterol, blood pressure and triglycerides. Diabetes runs in her family. Relatives have had strokes caused by the disease, and her mother died from complications of diabetes.

“I only saw one direction in my life,” Ms. Britton said. “I wasn’t able to control it. It was controlling me.”

She saw the study as a way to get expert help, and didn’t care which treatment group she wound up in. Still, when she learned that she had been picked at random to have a type of surgery called gastric bypass, she was frightened.

“It was kind of a shock, but I embraced it,” she said.

She had the operation in January 2009. Within a few months, she was off medications for diabetes, cholesterol, blood pressure and triglycerides. By May, she had lost about 80 pounds. As many people do, she gained some weight back, about 13 or 14 pounds. But her health has remained good, and she said that was what mattered most to her and her husband.

“I would do it again in a heartbeat,” she said. “It’s been a total blessing.”