Weight Loss Surgery Seems to Be a Diabetes Game-Changer

Obese diabetes patients showed most improvement with gastric bypass compared to other weight loss options

(RxWiki News) To fight diabetes, patients can make changes in diet and exercise, take medication, or in some cases, undergo weight loss surgery. For the obese, surgery has been shown to cut both weight and diabetes risk.

Recent studies have shown the benefits of weight loss surgeries. Designed to limit the amount of calories patients can eat, these surgeries have improved blood sugar control and reduced medication use in people with diabetes.

In two recent studies, gastric bypass surgery appeared to be the most effective in treating type 2 diabetes in obese people compared to gastric banding and lifestyle interventions (such as diet and exercise).

"If your doctor has recommended weight loss surgery, compare your options."

Anita P. Courcoulas, MD, of the Department of Surgery at the University of Pittsburgh, Medical Center, led one of the recent studies weighing the effectiveness of weight loss (bariatric) surgery on type 2 diabetes.

Dr. Courcoulas and her colleagues followed 61 obese patients with a body mass index (BMI) of 30 to 40. BMI is a number calculated from a person's weight and height that reveals if they are overweight, underweight or a healthy weight. According to the Centers for Disease Control and Prevention (CDC), a BMI of 30 or higher is obese, while 25 to 29.9 is overweight and 18.5 to 24.9 is normal.

The study participants received different weight loss interventions. A total of 20 patients underwent Roux-en-Y gastric bypass (RYGB), 21 had laparoscopic adjustable gastric banding (LAGB), and 20 pursued an intensive lifestyle weight loss intervention designed to encourage weight loss, healthy eating and exercise.

A gastric bypass is one of the most common types of weight loss surgeries. The operation limits the amount of food a person can eat. In a typical bypass, a stomach pouch may be created out of a small portion of the stomach and attached directly to the small intestine, thus bypassing a large part of the stomach and duodenum (first section of the small intestine).

With gastric banding, a surgeon inserts a band around the upper part of the stomach to create a small pouch to hold food.

At the one-year mark of this first study, patients who had RYGB had the largest drop in weight — an average 27 percent loss. LAGB patients shed 17.3 percent of their weight, while those in the lifestyle group had a 10.2 percent dip in weight.

Half of the patients in the RYGB group had partial diabetes remission and 17 percent achieved complete remission. In the LAGB group, 27 percent had partial remission and 23 percent had complete remission. No member of the lifestyle intervention group reached partial or complete remission during the 12-month period.

The researchers defined partial remission as having HbA1c levels (a measure of average blood sugar) of less than 6.5 percent and FPG (fasting plasma glucose) levels of 125 milligrams per deciliter (mg/dL) or less while not taking diabetes medication. For full remission, HbA1c levels had to be less than 5.7 percent with FPG levels at 100 mg/dL or less.

“Our preliminary results indicate that RYGB was the most effective treatment for weight loss and [type 2 diabetes] outcomes at 1 year, followed by LAGB,” Dr. Courcoulas and team concluded.

A related but smaller second study conducted by Florencia Halperin, MD, of the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women’s Hospital in Boston, and colleagues followed 19 RYGB patients with diabetes and 19 who had medical/weight management intervention. The intervention patients received individual changes to their medications, participated in supervised group exercise and made changes to their diets.

After 12 months, 58 percent of the RYGB group reached HbA1c levels below 6.5 percent and fasting glucose below 126 mg/dL, while only 16 percent of the intervention group reached that target. The researchers noted that weight, waist circumference, fat mass, lean mass, blood pressure and triglyceride levels decreased more in the RYGB participants and HDL (the “good”) cholesterol increased more than in those those who did not have surgery.

The studies were published online June 4 in JAMA Surgery.

The first study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (NIKKD-NIH) and by subsidization of the surgical procedures by Magee Women’s Hospital of the University of Pittsburgh Medical Center. Dr. Courcoulas has received research grants from Covidien, EndoGastric Solutions and Nutrisystem, and she is on the scientific advisory board of Ethicon J & J Healthcare system.

The Brigham and Women’s Hospital study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, the Marietta Blau grant from the Österreichischer Austausdienst, and the Herbert Graetz Fund. Covidien also provided some funding. Lifescan, a Division of Johnson & Johnson, provided home glucose monitoring supplies, Nestle Nutrition Inc. provided Boost, and Mercodia provided assay materials.

Review Date: 
June 4, 2014