|
 Both studies found that blood sugar levels were more likely to
improve among people who were randomly assigned to have surgery than
among those who went through intensive diet and lifestyle programs
instead.
The studies included people on the lower end of the obesity
spectrum, some of whom wouldn’t be recommended for surgery under
current guidelines.
“In appropriate patients, this is something really worth
considering,” said Dr. Allison Goldfine. She worked on one of the
studies at the Joslin Diabetes Center and Harvard Medical School in
Boston.
“There are multiple health issues that are related to type 2
diabetes,” she told Reuters Health, such as high blood pressure and
cholesterol.
“It’s very important to address these issues to improve (people’s)
health. I think this can be done through an intensive medical and
weight management program, and I think this can be done through
surgery,” Goldfine said. “One has to individually weigh the pros and
cons.”
Obesity and diabetes are known to be closely linked. But there is a
lack of long-term evidence on whether weight-loss surgery helps
alleviate diabetes and related complications, researchers say,
especially among people who are obese but not morbidly obese.
In one of the new studies, Dr. Anita Courcoulas from the University
of Pittsburgh Medical Center and colleagues tracked 61 obese people
with diabetes who were randomly assigned to undergo gastric bypass
or gastric banding surgery or to complete a weight control program.
One year later, half of gastric bypass patients and about
one-quarter of the gastric banding group had at least partial
remission of their diabetes, meaning their blood sugar levels were
closer to the normal range and they didn’t need diabetes
medications.
No patients in the non-surgery group saw their diabetes go into
remission.
In Goldfine’s study, researchers randomly allocated 38 patients -
all obese, all with diabetes – to gastric bypass surgery or a group
weight loss program.
One year later, 11 out of 19 gastric bypass patients met the goal
for a drop in blood sugar levels. That compared to three out of 19
in the other group.
Both trials were published in JAMA Surgery.
The studies included people with a body mass index, or BMI, between
30 and 40 or between 30 and 42.
BMI measures weight in relation to height. For example, both a
five-foot, six-inch person who weighs 186 pounds and a six-foot
person who weighs 221 pounds have a BMI of 30.
The National Institutes of Health and other groups say weight-loss
surgery is an option for people with a BMI of 40 or above who have
no weight-related complications or a BMI of 35 or higher if they
also have diabetes, sleep apnea or other problems.
Weight-loss surgery requires a drastic change in eating habits and
can come with complications such as hernias, leakages and
gallstones, as well as nutritional deficiencies.
[to top of second column] |
“Right now people with lower BMIs would not typically be covered by
insurance, but there is this growing body of data that potentially
supports the use of these procedures” among people with diabetes and
a BMI of 30 or above, Courcoulas said.
“It’s going to take putting several of these trials together in
order to determine whether these recommendations should be moved,”
Goldfine added.
She said that it’s important for people to consider surgery not just
as a weight management issue, but as a diabetes management issue as
well.
The trial results are in line with larger but less rigorously
designed studies of people who decided on their own whether to get
weight-loss surgery. That type of study can’t take into account all
of the potential differences between people who do and do not have
surgery, for instance that doctors might be more likely to refer
healthier patients for the procedures.
Long-term results from one such study were published by Dr. Lars
Sjostrom of Sahlgrenska University Hospital in Gothenburg, Sweden
and colleagues this week in JAMA.
They followed 343 obese people with diabetes who decided to undergo
one of three types of weight-loss surgery and another 260 who did
not have surgery.
Two years later, 72 percent of the surgery patients had remission of
their diabetes, compared to 16 percent of non-surgery patients. But
diabetes returned in some of them, and 15 years after surgery,
remission rates were down to 30 percent and seven percent,
respectively.
Researchers say the small, randomized studies could set the stage
for a larger trial comparing surgery and lifestyle interventions for
diabetes. But challenges exist, such as recruiting enough
participants who are willing to have their treatment randomly
assigned.
Courcoulas told Reuters Health that for now, a more likely scenario
is that data from multiple small trials will be combined into one
larger analysis. Researchers will also keep following the current
patients to see how they fare a few years after the treatments, she
said.
SOURCE: http://bit.ly/1olCVGY and http://bit.ly/1hQlThf JAMA
Surgery, online June 4, 2014 and http://bit.ly/ST5ywP JAMA, online
June 10, 2014.
[© 2014 Thomson Reuters. All rights
reserved.] Copyright 2014 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
 |
