Surgery Could Be Good Option for Obese People with Diabetes

Roux en Y gastric bypass surgery cut risk for heart disease in obese type 2 diabetes patients

(RxWiki News) Type 2 diabetes is often diagnosed in overweight patients. The combination of diabetes and obesity can present a serious risk for heart disease.

Typical treatment for type 2 diabetes involves specific weight management plans that include diet, exercise, blood sugar monitoring and medicine.

New research found merit in that approach, but patients who received gastric bypass surgery lost more than four times as much weight as patients who just went through a clinical support program.

"Consult an endocrinologist about diabetes treatments to consider."

Su Ann Ding, MD, MBBS, a research fellow at the Joslin Diabetes Center in Boston, Mass., led this research.

Dr. Ding and colleagues set out to compare how a weight loss surgery compared to clinical support in helping overweight patients with type 2 diabetes reduce the risk of heart disease using body mass index (BMI) and other measures.

BMI is a measure of body fat based on height and weight.

Type 2 diabetes is a lifelong condition in which the body stops responding to insulin, a hormone produced by the pancreas that moves blood sugar into cells where it’s converted to energy.

People with type 2 diabetes have to monitor their blood sugar and often take prescription medications.

Dr. Ding and team focused on 38 obese patients between 21 and 65 years old who had type 2 diabetes for at least one year, a BMI between 30 and 42 (marking obesity) and an expressed desire for weight loss and clinical assistance.

None of the participants had heart disease and none had smoked for at least two months.

The researchers randomly assigned the 38 study participants to have either Roux-en-Y gastric bypass surgery or to take part in a weight management program designed for diabetes patients.

Roux-en-Y gastric bypass surgery creates a pouch in the stomach and attaches it to the intestine. That makes the stomach too small to hold a lot of food and reduces fat absorption.

The support program involved patients working with an endocrinologist, a registered dietician, an exercise physiologist, a mental health specialist and a diabetes nurse educator.

According to the study results, both groups lost significant weight and kept it off for two years, although the group that underwent surgery lost more.

On average, the gastric bypass group lost 57 pounds or 25 percent of their initial body weight.

The group in the support program lost an average of 13 pounds or 6 percent of their initial body weight.

The surgical group also showed improved blood sugar control, improved blood pressure and improved cholesterol.

"There is emerging evidence highlighting the potential health benefits of bariatric surgery in managing obese patients with type 2 diabetes,” Dr. Ding said in a prepared statement.

“In the past, lifestyle advice and medications provided the mainstay of treatment for this group of patients, but despite the substantial improvements in pharmacotherapy for adults with type 2 diabetes, many patients still do not achieve targeted health goals," Dr. Ding said.

Dr. Ding called gastric bypass surgery “an acceptable therapeutic option for risk reduction in heart disease in obese patients with type 2 diabetes in whom surgical risk is not excessive.”

This research was presented June 23 in Chicago at a joint meeting of the International Society of Endocrinology and the Endocrine Society.

Funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases and from private companies, including Johnson and Johnson and Nestle Nutrition, Inc.

The authors did not disclose any conflicts of interest.

Review Date: 
June 30, 2014