Weight Loss may beat treatments for diabetes

A new international analysis comparing weight-loss procedures to standard diabetes treatments contends that surgery is more effective at helping people combat type 2 diabetes. The finding stems from two years of tracking 60 severely obese patients with type 2 diabetes who were between the ages of 30 and 60. One-third of the patients were treated with diabetes drugs and diet/lifestyle modifications, while the rest underwent one of two surgical procedures: either Roux-en-Y gastric bypass or biliopancreatic diversion surgery. The end result: all of the surgical patients were ultimately able to stop taking their diabetes medications, while the vast majority entered into full disease remission; neither outcome occurred in the traditional treatment group. "We have known for many years that bariatric surgery, and specifically certain types of operations like gastric bypass, are very effective in terms of helping to control diabetes," noted study senior author Dr. Francesco Rubino, chief of gastrointestinal metabolic surgery and director of the Metabolic and Diabetes Surgery Center at New York-Presbyterian/Weill Cornell in New York City. "But what this new study shows is that even when you compare surgery against standard treatment, surgery performs far better in terms of the improvement that you can get in terms of diabetes," he continued. "Surgery dramatically reduces blood sugar levels, and very often surgical patients can stop taking the medications used for diabetes." Rubino and his colleagues from Rome's Catholic University report their findings in the March 26 online edition of the New England Journal of Medicine, to coincide with a planned presentation on the findings at the American College of Cardiology annual meeting in Chicago. Cleveland Clinic researchers report similar findings in the same journal and plan to present the results at the same cardiology meeting. In their study, the Cleveland Clinic doctors followed 150 patients with type 2 diabetes for a year, and found those who had undergone one of two types of weight-loss surgeries were much more likely than those on traditional therapies to get their blood sugar levels lowered to an optimal point and reduce their use of diabetes medications. The Italian study authors pointed out that standard medicinal therapies, while effective, can pose their own set of problems. For one, insulin therapy can cause patients to gain weight, which itself can have a negative impact on diabetes. To explore the comparative benefit of surgical options, the team focused on 60 diabetic patients who had a body mass index (BMI) of 35 or more (BMI is a measurement that takes into account height and weight, and over 30 is considered obese); all had a minimal five-year history of struggling with diabetes. Undergoing treatment in Rome, the patients were randomly divided into three groups. The first was treated with conventional insulin therapy and a range of other hypoglycemic drugs, alongside what was described as "rigorous" dietary and exercise counseling. The second and third group had one of the two types of bariatric surgery, and were placed on a daily regimen of vitamin and mineral supplementation. The research team found that all of the surgical patients were able to stop taking all diabetes medications within just 15 days. What's more, at the two-year mark, three-quarters of those who underwent Roux-en-Y gastric bypass surgery had entered diabetes remission, meaning that for a minimum of one year they had a fasting glucose level under 100 milligrams/deciliter and a hemoglobin A1c count of less than 6.5 percent. The same was true among 95 percent of the biliopancreatic surgery group. By contrast, none of the patients in the standard treatment group had entered remission. The team observed that BMI levels, diabetes history, postsurgical weight loss, age and gender did not appear to play a role in the likelihood that patients would enter into diabetes remission. "Two years is a relatively short outcome," acknowledged Rubino. "And this was a small study. But the effect of surgery was almost immediate among the surgical patients. And I think it's clear that while patients getting medicinal therapy did improve somewhat, the chance for patients to achieve robust improvement in diabetes is much greater for those who have surgery than those who are treated with standard medications." Dr. Loren Wissner Greene, an endocrinologist at NYU Langone Medical Center in New York City, expressed little surprise at the findings. "That's been widely reported," she noted. "Of course, how one fares does depend on the individual. One can eat around any procedure, meaning that if a patient drinks high-caloric liquids following surgery, and manages not to lose weight, that can affect the result," Greene explained. "At the same time, there is very good evidence for diabetic remission after surgery, particularly for diverting procedures, where there could be a beneficial impact on gut hormones like leptin and ghrelin," Greene added. "There are some risks, however," she cautioned. "And people who have bad presurgical problems -- those with high blood pressure or obesity-related sleep apnea -- might be limited in terms of the type of obesity surgery they can get. But for those who can do it, it may really be the better way to go. And in the end, though surgery is extremely expensive, it might even be cheaper than having to take expensive diabetic medications for years to come."