Weight Loss Surgery and Diabetes

Obese type 2 diabetes patients undergoing gastric bypass may send diabetes into remission

(RxWiki News) For obese individuals who have had trouble losing weight, gastric bypass surgery may be an effective option. For those who also have diabetes, the surgery may come with an added bonus—stopping diabetes.

According to a newly published report, the gastric bypass operation may also trigger insulin release from the pancreas, restoring normal blood sugar levels and reversing type 2 diabetes.

“Despite similar weight loss as sleeve gastrectomy, gastric bypass uniquely restores pancreatic cell function and reduces truncal fat, thus reversing the core defects in diabetes," wrote the study authors.

"Ask a doctor about gastric bypass surgery."

Sangeeta R. Kashyap, MD, of the Department of Endocrinology, Diabetes and Metabolism at the Cleveland Clinic in Ohio, headed up research looking at moderately obese patients who had bariatric surgery.

Investigators followed 54 patients who had a body mass index (BMI) around 36.

BMI is basically a measure of your weight in relation to your height. Obesity in general is defined as having a BMI of 30 to 39.9. BMI between 25 and 29.9 is overweight. Morbidly obese people have a BMI of 40 or higher, and their weight is 100 pounds or more greater than their ideal weight.

Dr. Kashyap noted that most previous studies on this topic have focused on the morbidly obese, while this research targeted the moderately obese.

A measure of glycated hemoglobin in the blood is used to diagnose diabetes. A glycated hemoglobin test, or a hemoglobin A1C  (HbA1c) test, provides an average of blood sugar control over a two to three month period. In people without diabetes, HbA1c is usually between 4 percent and 6 percent. In this study, the average HbA1c for patients was 9.2 percent.

The researchers were interested in comparing intensive medical therapy (IMT) with surgical treatment (gastric bypass or sleeve gastrectomy) as a means of improving HbA1c in moderately obese patients with type 2 diabetes.

IMT as defined by the American Diabetes Association guidelines includes lifestyle counseling, weight management, frequent home glucose monitoring and the use of newer drug therapies (eg, incretin analogues) approved by the Food and Drug Administration (FDA).

Sleeve gastrectomy is similar to a gastric bypass but involves a stapling procedure that creates a banana-sized pouch or sleeve from the stomach. The rest of the stomach is removed.

After two years of following the patient groups, researchers found that the average HbA1c had dropped from 9.2 percent to 6.7 percent for those with gastric bypass, to 7.1 percent for those with sleeve gastrectomy and to 8.4 percent for those who followed IMT.

Results showed that gastric bypass (specifically called Roux-en-Y gastric bypass) to be a significantly better option than either sleeve gastrectomy or IMT.

The study was published in February in Diabetes Care. The 54 patients involved in this research were originally part of a bigger study called Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE). The STAMPEDE trial was supported by funding from Ethicon Endo-Surgery, a clinical translational award from the American Diabetes Association, and a grant from the National Institutes of Health.

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Review Date: 
March 7, 2013