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 In their study of different types of so-called bariatric surgeries,
the biggest impact on diabetes remission was seen with gastric
bypass, which can reduce the size of the stomach from about three
pints to roughly the size of a shot glass.
The researchers studied 569 obese patients with type 2 diabetes who
had different types of weight-loss operations and 1,881 similar
diabetics who didn’t have surgery. Altogether, the surgical patients
had an almost 18-fold greater chance of experiencing remission,
meaning their elevated blood sugar returned to a healthy level
common in people without diabetes.
Compared to results without surgery, remission was about 43 times
more likely in patients who had gastric bypass, and almost 17 times
more likely for patients who had procedures known as sleeve
gastrectomies, which reduce the stomach to the size of a banana.
Remission was about seven times more likely when patients had
gastric banding, which can be less invasive and reversible but also
result in less weight loss.
While the findings suggest that diabetics might benefit from
bariatric surgery in general, and gastric bypass in particular,
there isn’t enough long-term data yet to say whether these
operations might make sense for diabetics who are not obese, said
co-author Frank de Vries, a pharmacist at Maastricht University and
Utrecht University in the Netherlands.
“There is no strong evidence to date that support recommending
bariatric surgery for the management of type 2 diabetes alone, in
the absence of obesity,” de Vries said by email.
Surgical weight loss has gained traction in recent years as a
growing number of extremely obese patients turn to this option after
failing to lose weight through diet, exercise or medication –
strategies that can also manage diabetes. Like all surgery,
bariatric operations are not risk free, and in particular they carry
a risk of malnutrition.
One limitation of the study is that the data came from primary care
providers in the U.K. rather than from hospital or specialist
records, the authors acknowledge in JAMA Surgery. It’s also possible
some data might have been incomplete.
Even so, it may still make sense to prioritize obese patients with
diabetes for bariatric surgery, Martin Neovius, a researcher at
Karolinska Institute in Stockholm who wasn’t involved in the study,
said by email.
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The findings also add to a growing body of research suggesting that
gastric bypass may be the best surgical option for lowering blood
sugar, Dr. Ricardo Cohen, a diabetes researcher at Oswaldo Cruz
German Hospital in Sao Paulo who wasn’t involved in the study, said
by email.
But it doesn’t mean surgery is for everyone, said Sheri Colberg, a
professor of exercise science at Old Dominion University in Norfolk,
Virginia.
“The benefits of improving diet and becoming more physically active
should never be discounted – either for weight loss or diabetes
management,” Colberg, who wasn’t involved in the study, said by
email.
Roughly one in nine adults have diabetes, and the disease will be
the seventh leading cause of death by 2030, according to the WHO.
Most of these people have type 2, or adult-onset, diabetes, which
happens when the body can't properly use or make enough of the
hormone insulin to convert blood sugar into energy. Left untreated
it can lead to nerve damage, amputations, blindness, heart disease
and strokes.
SOURCE: http://bit.ly/1FSZtrN JAMA Surgery, published online
September 30, 2015.
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