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 Gastric bypass surgery precipitates weight loss and also triggers
hormonal and metabolic mechanisms that work against diabetes
specifically, beyond just weight loss, said lead author Dr. David E.
Cummings of the University of Washington in Seattle.
“The new thinking is might we begin to see surgery as a way to treat
diabetes primarily,” Cummings told Reuters Health.
The researchers assigned 23 obese adults ages 25 to 64 years with
type 2 diabetes to receive gastric bypass, in which surgeons reduce
the size of the stomach and also bypass a portion of the intestines.
Another 20 similar patients instead received an intensive lifestyle
intervention that included at least 45 minutes of aerobic exercise
five days per week, a dietitian-directed weight and blood sugar
lowering diet as well as diabetes medical treatment for one year.
Eleven participants withdrew before completing the trial, so 15 in
the surgery group and 17 in the lifestyle intervention group
remained to be studied after one year.
Researchers measured participants’ fasting blood sugar and insulin
levels, sensitivity to insulin, body weight, waist circumference,
body composition, blood pressure, cholesterol, aerobic fitness,
medication usage and quality of life before the study began, after
six months and after 12 months.
At the one year point, 60 percent of those in the gastric bypass
group had lowered their blood sugar into the non-diabetic range,
compared to 6 percent of those in the diet and exercise group. Less
than 30 percent of participants in the gastric bypass group were
using insulin after one year compared to 41 percent of the lifestyle
change group, as reported in Diabetologia.
Surgical patients were also using fewer blood pressure medications
after one year than lifestyle-change patients.
Body weight, waist circumference, waist-to-hip ratio and percent
body fat mass decreased in both groups over time, although surgical
patients lost more weight and fat mass.
Cardiorespiratory fitness, measured by peak oxygen consumption
during exercise, increased for the diet and exercise group but did
not change for the surgery group.
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“The uniqueness of this study lies in the fact that the lifestyle
intervention control group used what was considered to be the most
strict program practical for such patients with diabetes that was
patterned after the well-known Diabetes Prevention Program and Look
Ahead trials,” and patients were recruited from a broad population
within a healthcare system, said Nathan D. Wong, director of the
Heart Disease Prevention Program at the University of California,
Irvine.
Clearly surgery is much more effective than intensive lifestyle
change for causing remission of diabetes, but surgery should still
be the last option, Wong told Reuters Health by email.
“Patients with pre-diabetes (and even before that) should be more
conscious of their lifestyle and what they can do to prevent
diabetes as the Diabetes Prevention Program and other similar
studies have clearly shown modest weight loss and exercise can go a
long way towards preventing diabetes,” he said. “Healthcare
providers (and insurers alike) need to provide better support and
resources to effect intensive lifestyle intervention.”
In current practice, patients are not generally given the long-term
lifestyle programs that should be tried before surgery, he said.
“In those with severe or morbid obesity where multiple lifestyle
intervention attempts have been unsuccessful, gastric bypass surgery
is felt to be a good option by many experts,” Wong said. “There are
always potential risks with such surgeries such as excessive
bleeding, clotting, or infections, and surgery of course is not
reversible.”
SOURCE: http://bit.ly/1Rz1sa6 Diabetologia, online March 17, 2016.
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