Surgery May Cut Weight and Diabetes Risk

Diabetes patients who have weight loss operation may improve condition but face complications

(RxWiki News) While losing weight through exercise and eating healthy can help people control diabetes, gastric bypass surgery can offer dramatic results for those with mild or moderate obesity.

When you lose weight, you can lose a host of health problems as well.

Researchers have recently discovered that obese patients who have gastric bypass surgery to lose weight may improve diabetes risk factors, such as blood sugar, LDL cholesterol and systolic blood pressure.

The report warns, though, that the operation carries its own risks.

"Obese? Consider weight loss surgery to improve diabetes risk factors."

Sayeed Ikramuddin, MD, director of gastrointestinal/bariatric surgery at the University of Minnesota in Minneapolis, and colleagues conducted an investigation to compare Roux-en-Y gastric bypass with lifestyle and intensive medical management to control diabetes.

Over the course of 12 months, Dr. Ikramuddin and his team followed 120 patients who had a hemoglobin A1c (HbA1c) level of 8.0 percent or higher, body mass index (BMI) between 30.0 and 39.9, C peptide level of more than 1.0 ng/mL, and type 2 diabetes for at least six months.

The Centers for Disease Control and Prevention defines obesity as a BMI of 30 or higher. C peptide levels estimate the body's insulin production.

Half the patients received Roux-en-Y gastric bypass and followed lifestyle changes and intensive medical management, and half only followed the lifestyle changes and medical management. HbA1c measures how well diabetes is managed over time.

A gastric bypass is one of the most common types of weight loss, or bariatric, surgeries. The operation limits the amount of food a person can eat. The Roux-en-Y gastric bypass procedure involves creating a stomach pouch out of a small portion of the stomach and attaching it directly to the small intestine, bypassing a large part of the stomach and duodenum.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says that the surgery is usually for men who are at least 100 pounds overweight and women who are at least 80 pounds overweight. For those who are somewhat less overweight, surgery still might be an option if a person also has diabetes, heart disease or sleep apnea.

Investigators in this study were interested in seeing which patients could reach benchmarks for diabetes control established by the American Diabetes Association (ADA). These goals are HbA1c of less than 7 percent, LDL cholesterol less than 100 mg/dL and systolic blood pressure less than 130 mm Hg.

At the end of the study, 11 participants (19 percent) in the lifestyle-medical management group met the ADA's composite health goal while more than double that number (28 participants, or 49 percent) hit the mark in the gastric bypass group.

After a year, the surgery group had much greater weight loss as well. Average weight loss was 26 percent for those who had gastric bypass versus 8 percent for the other group.

Scientists noted that the gastric bypass group also used 3.0 fewer medications to manage glycemia, dyslipidemia and hypertension than did those in the lifestyle-medical management group.

“The gastric bypass group also had significantly better results for the secondary outcomes of glycemia, HDL cholesterol, triglycerides and diastolic blood pressure," wrote the authors.

On the negative side, however, more gastric bypass patients experienced a nutritional deficiency. In addition, 22 gastric bypass patients had serious adverse events compared to 15 of the patients in the lifestyle-medical management group.

"The benefits of applying bariatric surgery must be weighed against the risk of serious adverse events,” wrote Dr. Ikramuddin and co-authors. “Bariatric surgery can result in dramatic improvements in weight loss and diabetes control in moderately obese patients with type 2 diabetes who are not successful with lifestyle changes or medical management.”

In an accompanying editorial, Bruce Wolfe, MD, of Oregon Health and Science University in Portland, Oregon, and colleagues said, “Bariatric surgery does result in substantial weight loss with excellent diabetes control but is offset by initial high cost and risks for surgical complications. The optimal approach for treatment of obesity and diabetes remains unknown. The answer will only come from more well designed, randomized trials such as that performed by Ikramuddin et al that provide definitive answers."

The study was published in the June 5 issue of the Journal of the American Medical Association.

Review Date: 
June 5, 2013