Weight Loss Surgery Cuts Type 2 Diabetes

It’s been less than one month since two studies — conducted independently by researchers in the United States and Italy — concluded that bariatric surgery may be the best treatment for obese people who suffer from type 2 diabetes.

Now a new study, conducted by yet another institution, also in Italy, comes to the same conclusion. All three studies found that patients who underwent weight loss surgery enjoyed improved diabetes outcomes compared to patients who received standard therapy and medications to control diabetes.

Obesity and diabetes are two major health challenges across the world, and for both diseases, the increasing prevalence has reached epidemic proportions. Even as the prevalence of diabetes in the U.S. and across the world is surging in parallel with obesity’s rise, the link between the two conditions is also well established: Some 80 percent of the 23 million adult Americans who have type 2 diabetes are either overweight or obese.

If children are included, the number of people in the U.S. living with type 2 diabetes comes to about 25.8 million and about 1.9 million new cases were diagnosed in 2010. And the annual cost of caring for patients with diabetes will approach US$192 billion in 2020, according to the American Diabetes Association.

In the latest of the three studies — involving 60 morbidly obese patients with type 2 diabetes — researchers from the University of Rome in Italy find that patients were cured of their diabetes a year and a half after undergoing bariatric surgery. The findings of the study, led by Dr. Frida Leonetti of the Policlinico Umberto I, University of Rome’s teaching hospital, are published in the Archives of Surgery April 16 issue.

That new study comes on the heels of two randomized trials published late last month in the New England Journal of Medicine. Similarly, the two trials found that compared to medications, two forms of bariatric surgery — including Roux-en-Y gastric bypass and sleeve gastrectomy — led to significantly better control of diabetes.

Latest study shows: gastrectomy works
In the latest study, the University of Rome researchers divided the 60 participants into two groups:
• Half the patients underwent laparoscopic sleeve gastrectomy, or LSG.
• The other half received conventional medical therapy for type 2 diabetes.

LSG is surgical procedure in which a surgeon removes a major portion of the stomach and leaves a small banana-shaped pouch — usually about 20 to 25 percent of the original size of the stomach. This fills up quickly when a person eats, limiting the amount of calories taken in. The procedure is considered minimally invasive.

In the two previous studies, other bariatric surgeries were used:
• A biliopancreatic diversion — in which part of the stomach is removed to reduce its capacity
• Roux-en-Y bypass — in which the stomach is shrunk by stapling off a large part of it.
• In both procedures, the stomach is relocated so that its contents are routed past much of the lower intestine, where the most calories and nutrients are absorbed.
• In contrast, sleeve gastrectomy doesn’t move the stomach or alter the way food enters or leaves it.

Conventional medical therapy for diabetes, for its part, involves medical staff consultations, lifestyle modifications, medications, regular physical activity and a 1200-calorie diet.

What the Italian researchers found was that 18 months after their surgery:
• 80 percent of patients who underwent the surgery were cured of diabetes
• Their BMI — which averaged 41.3 before the LSG procedure — was reduced to 28.3 after the study period. A person with a BMI of 30 or above is considered obese.
• Patients who received diabetes medications didn’t improve and remained diabetic during and after the study.
• Patients who underwent surgery also enjoyed improvements in blood pressure, cholesterol levels and obstructive sleep apnea.
• Over time, medically treated patients required more medication for blood pressure and cholesterol control.