Study Shows Surgery Promising for Resolving Diabetes

Are you overweight? Do you have Type 2 Diabetes? If so, weight-loss surgery can be a major factor in reversing your diabetes and improving your quality of life, according to a study published this week in The New England Journal of Medicine.

The study shows a link between weight-loss surgery and the reversal of type 2 diabetes, something bariatric surgeons have seen.

“As bariatric surgeons, we’ve known that diabetes goes away much earlier in patients who undergo gastric bypass surgery,” says Anthony Gonzalez, M.D., a Baptist Health Medical Group surgeon and medical director of South Miami Hospital’s Weight-loss Surgery Program.  “This study – the first long-term study – validates what we’ve seen in our own patients.”

How was the research conducted?

During a 36-month period, the research team studied 150 patients who were obese and had uncontrolled type 2 diabetes.

The participants were divided into two groups. One group was given “intensive medical therapy,” consisting of insulin and other glucose-lowering medicines. The second group received that same medicine, plus weight-loss surgery, either Roux-en-Y gastric bypass or sleeve gastrectomy.

What did the results show?

“Among obese patients with uncontrolled type 2 diabetes, three years of intensive medical therapy plus bariatric surgery resulted in glycemic control in significantly more patients than did medical therapy alone,” according to the research team.

Approximately, 37 percent of patients who had gastric bypass  surgery and nearly 25 percent of those who had a gastrectomy  no longer needed to take insulin and other medications to control diabetes. That compares to only 5 percent who were in the medicine-only control group, according to the report.

The patients who received the combination of glucose-lowering medicine and weight-loss surgery fared better on several other fronts as well, according to the research data.

• Less medicine needed: After weight-loss surgery, the sample group used lower amounts of insulin-lowering medicine and medications to treat high blood pressure and cholesterol, relative to the peers who did not undergo surgery.
• Greater weight loss: On average, the patients who had gastric-bypass surgery lost 24.5 percent of their weight; patients who had a sleeve-gastrectomy lost 21.1 percent. But the medicine-only group lost just 4.2 percent, according to the study.
• Better quality of life: Compared to the medicine-only control group, the surgical group reported a “significantly” better quality of life based on several measures.

“The resolution of diabetes in gastric bypass patients, we think, comes from the diversion of food away from the duodenum, or entry point into the small intestine,” Dr. Gonzalez says.  “With sleeve gastrectomies, that diversion doesn’t occur, but the diabetes resolution happens when patients begin losing weight following their surgery.”

And there may be even more promising breakthroughs for surgical treatment of type 2 diabetes, he says.

“Trials are currently underway to test a device that blocks food absorption in the duodenum and has been shown to resolve diabetes,” Dr. Gonzalez says. “The device is placed endoscopically, therefore avoiding weight-loss surgery to cure diabetes.”