Diabetes and Bariatric Surgery

An editorial in The New England Journal of Medicine pulled no punches about the rapid spread of the most common form of diabetes. "Type 2 diabetes," it firmly stated, "is one of the fastest growing epidemics in human history."

In the past thirty years, the prevalence of Type 2 diabetes has tripled. At the present time, it affects approximately 26.5 million adults, accounting for than 95 percent of all diagnosed adult cases of diabetes. A 2010 working paper by the United Health Center for Health Reform & Modernization projects that by 2020 about 10.8% of the American adult population will be diagnosed with this increasingly common metabolic disease.

There are numerous risk factors for Type 2 diabetes. Having a close relative who is or was diabetic raises your chances of developing the disease. People who have had a stroke or become temporarily diabetic while pregnant (gestational diabetes) also are more likely to develop Type 2.

Certain ethnic groups are more prone to developing this disease as they grow older; black people and South Asians show an increased risk if they are older than 25. White people have an increased risk once they pass the age of 40. As other ethnic groups have adopted Western "fast food" eating habits, researchers are beginning to see an increase in their risk factors as well.

Bodyweight is, however, the biggest risk factor.

It is estimated that four-fifths of people who have Type 2 are overweight. Studies show a direct correlation between excess pounds and increased risk with the risk factor further increased by lack of exercise.

Since excessive weight and sedentary habits make one more likely to develop this dangerous disease, does the healthier lifestyle adopted by people after they have bariatric surgery decrease the chances of having to live with Type 2 diabetes?

The answer is a resounding yes! Best of all, evidence is beginning to show weight loss surgery may even cure Type 2 diabetes in some cases.

Researchers from Catholic University in Rome, Italy and New York-Presbyterian Medical Center recently reported that bariatric surgery significantly outperformed standard medical treatment of this metabolic disease.

Evaluating remission of diabetes in 60 obese patients, they randomly assigned them to three groups. One group had Roux-en-Y gastric bypass surgery, a second group had duodenal switch surgery and the third received a treatment involving individualized medication and meticulously monitored lifestyle modifications, including a diabetic diet.

Researchers defined remission as fasting glucose of less and 100 mg and hemoglobin A1c of less than 6.5 percent. If these results held constant for a year, they considered the remission maintained.

By this definition, remission occurred and was maintained in 19 of the 20 patients who had duodenal switch surgery. The Roux-en-Y gastric bypass surgery groups saw 15 of their 20 person team members experience remission and maintain those results. In startling contrast, not one of the patients in medication-lifestyle group has gone into remission since the start of the study.

These results were reinforced by a recent study at the Cleveland Clinic in Cleveland, Ohio.

For this trial, researchers divided 150 obese patients with poorly controlled diabetes into three groups. One group received intensive medical therapy plus gastric bypass surgery, the second group received intensive medical therapy plus sleeve gastrectomy and the third just received intensive medical therapy for their diabetes.

For the purpose of this study, the researchers measured the number of people who achieved a hemoglobin A1c of less than 6 percent after 12 months. Of the patients who underwent gastric bypass surgery, 42.6 percent of them hit that goal. An impressive 36.7 percent of those who had sleeve surgery also hit their blood sugar target. Unfortunately, only 12.2 percent of those who just received intensive medical therapy reached the 6 percent hemoglobin A1c goal.

A larger, longer study conducted in Sweden also sheds some interesting light on the topic of bariatric surgery and diabetes.

A research group led by Dr. Lars Sjstrm of Sahlgrenska University Hospital in Gothenburg, Sweden tracked 1,658 bariatric surgery patients and 1,771 similar patients who received weight loss information and counseling.

None of these individuals had diabetes when the study began. After a decade, 392 of the patients who had received the weight loss information and counseling developed diabetes yet only 110 of the bariatric surgery patients became diabetic.

By this measure, researchers calculate that weight loss surgery reduced the odds of getting diabetes by 78 percent.

Responsible members of the medical community caution that more long-term studies are needed before we can confidently define the relationship between bariatric surgery and diabetes but these positive results are encouraging and have led several institutions, including the Cleveland Clinic, to extend their studies or begin new ones.

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