|
 Half of the patients treated with weight-loss surgery in the study
were diabetes-free at five years, said Dr. Francesco Rubino of Kings
College London in the UK and colleagues in a report in The Lancet.
“The five-year mark is an important mark in many diseases,” Dr.
Rubino told Reuters Health by phone. “The fact that some patients at
five years are basically disease-free is a remarkable finding.”
In 2009, he and his colleagues randomly assigned 20 obese patients
with type 2 diabetes to receive medical treatment, 20 to receive a
type of weight-loss surgery called a gastric bypass, and another 20
to undergo a weight-loss operation called a biliopancreatic
diversion.
Eighty percent of patients who had surgery had their blood sugar
under good long-term control, versus about 25 percent of patients
treated with drugs only.
All of the study groups had a reduction in cardiovascular risk. But
the surgery-treated patients had a 50 percent lower risk of heart
and blood vessel disease than those treated with drugs only, and
they needed fewer drugs for treating high blood pressure or high
cholesterol.
The improvements in blood sugar control and heart disease risk
weren’t related to how much weight patients lost.
“What really is causing the remission of diabetes after surgery
remains mysterious,” Dr. Rubino said. What is known, he added, is
that the intestines produce a host of hormones involved in
regulating metabolism. Reconstructing the gastrointestinal tract so
that food bypasses the stomach and small intestine may help restore
normal metabolic control, he explained.
Like any surgery, weight loss operations carry risks. An
international study published earlier this, for example, found that
after two years, people randomized to have gastric bypass surgery
had better control of their type 2 diabetes than people assigned to
a medication group, but they also had a higher risk for infections
and bone fractures. (See Reuters Health story of May 21, 2015.)
And some patients may gain back some of the weight they lost.
[to top of second column] |
Still, doctors are increasingly referring to this type of surgery as
“diabetes surgery,” rather than obesity surgery, said Dr. Philip
Schauer, the director of the Cleveland Clinic Bariatric and
Metabolic Institute and a bariatric surgeon, in a telephone
interview with Reuters Health. Dr. Schauer did not participate in
the new study.
“There are some people, this study shows, that can go into remission
for up to five years or more,” he said. “We hesitate to use the word
‘cure,’ but it’s pretty darn close to a cure, about as close to a
cure as you can get.’”
Dr. Schauer pointed out that about half of patients with type 2
diabetes are unable to control their blood sugar with medication and
lifestyle measures. Based on the new findings, he said, bariatric
surgery should be offered to these patients if they are moderately
obese, for example with a body mass index (BMI) of 35. (BMI is a
measure of weight in relation to height.)
Currently the National Institutes of Health states that patients
should have a BMI of 40, or a BMI of 35 with obesity-related
illness, such as type 2 diabetes, in order to be eligible for weight
loss surgery.
“There are still many insurance companies today that will not pay
for this surgery for any reason, whether it’s for obesity or
diabetes. It means that they are denying people effective
treatment,” Dr. Schauer said. “This study is going to make insurance
carriers and third party payers rethink their coverage policies
regarding bariatric or diabetes surgery, as we prefer to call it.”
SOURCE: http://bit.ly/1JTRaqX The Lancet, online September 3, 2015.
[© 2015 Thomson Reuters. All rights
reserved.] Copyright 2015 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed. |
