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Bariatric surgery better than intense medical therapy for obese diabetics

Kathleen Blanchard's picture
First study compares weight loss surgery to medical therapy for type 2 diabetes

Type 2 diabetes is found to improve and even remain in remission with obesity surgery, find researchers. Because diabetes is on the rise and expected to continue to increase, scientists are looking for ways to curb costs and save lives. One way may be through bariatric surgery known as laparoscopic sleeve gastrectomy (LSG).

The procedure leads to weight loss and is minimally invasive because it’s performed with a laparoscope. The result is a 25% smaller stomach. The surgery is most often performed on people who are severely obese and cannot lose weight with diet and exercise.

Usually, up to 85% of the stomach is removed. The intestines remain intact so there are no problems with malnutrition and other gastrointestinal problems. The surgery is considered safer than gastric bypass and laparoscopic gastric banding, though complications can occur.

Intensive medical therapy no help for severely obese diabetics

For their study, researchers from the Policlinico "Umberto I," University of Rome "Sapienza," Italy, compared standard type 2 diabetes medical care to surgery to find the impact of weight loss surgery on controlling blood sugar levels.

Compared to a group who had bariatric surgery, a second group who underwent intense medical treatment ended up increasing their medication and failed to lose any weight.

Sixty patients were included who were considered morbidly obese, with body mass index of 41.3 in the surgery group and 39 in the medically treated group.

Eighty percent of the patients who had gastric sleeve surgery lost body mass at 18 months that declined to 28.3; the medically treated group remained approximately the same weight – BMI was 39.8 after 18 months.

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"We found significant differences regarding excess weight loss, the decreases in BMI and triglycerides, and the increase of high density lipoprotein [HDL] cholesterol," the researchers write. "With a T2DM remission rate of 80% at 18 months, the results of the present study confirm the efficacy of LSG in the treatment of these patients.”

The current finding is the first to compare results among patients surgically treated and a group who were given intense medical treatment that included medical staff consultations, recommendations for lifestyle changes, medication therapy, a regimen of regular physical activity, and a restricted calorie diet. Past studies have shown type 2 diabetes can improve, and in some instances, be reversed with weight loss surgery.

"Midterm and long-term results are needed to confirm the positive effect (remission and/or improvement) of LSG on diabetes and, overall, on the chronic complications of the disease," the authors conclude. "Most importantly, the longer-term results will allow us to compare the costs and benefits of bariatric surgery vs conventional medical treatments."

Jon C. Gould, M.D., of the Medical College of Wisconsin, Milwaukee, who was invited to critique the findings, said "An obese diabetic patient should have access to bariatric surgery in appropriate clinical circumstances. This access should be uniform, consistent, and not subject to potential bias, differences in opinion, or a lack of understanding regarding contemporary bariatric surgery outcomes."

Gould suggests that national guidelines should be developed for people with type 2 diabetes whose body mass index is 35 or greater. Few physicians recommend the weight loss surgery to their patients, found in a recent survey, he adds.

The study shows laparoscopic sleeve gastrectomy – removing a large portion of the stomach – can help patients with type 2 diabetes, but more research will show if the weight loss surgery would be more cost effective than medical therapy for severely obese patients living with the disease. According to background information from the study, diabetes cost could reach close to $192 billion annually by the year 2020.

Arch Surg. Published online April 16, 2012.

Image credit: Morguefile