Rearranging GI tract for obesity also improves diabetes

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Bariatric surgery is gaining prevalence in the U.S., as more severely obese patients choose to go under the knife to improve their chances of losing excess weight. And since obese individuals are at a particularly high risk of type 2 diabetes, two new studies offer welcome news for patients who suffer from both obesity and diabetes: According to the study results, bariatric surgery may hold some impressive benefits for such patients, helping to reduce the toll of diabetes in addition to facilitating weight loss.

The two studies, published in The New England Journal of Medicine, evaluated the effects of combined medical therapy and bariatric surgery on obese patients with diabetes, as compared to regular or intensive medical care alone. In both cases, researchers found that patients fared significantly better with bariatric surgery than with medical care alone. In fact, many of these patients saw their diabetes go into remission.

For the first study, 60 severely obese patients with a BMI (body mass index calculated as body weight divided by height squared) of at least 35, who had had type 2 diabetes for at least five years, were randomly assigned to receive one of two types of bariatric surgery or to undergo regular medical treatment. Obesity is defined as a BMI of 30 or more, and severe obesity as a BMI of 35 or greater. Two years later, none of the medical therapy patients had experienced diabetes remission, while between 75 and 95 percent of the bariatric surgery patients had complete diabetes remission. (It should, however, be noted that diabetes remission is not necessarily permanent, and the disease can recur if diet and weight change significantly.)

The second study assessed 140 obese patients with diabetes who had a BMI between 27 and 43. Researchers randomized the participants to receive one of two forms of bariatric surgery or to receive intensive medical therapy. After a year of follow-up, only 12 percent of patients in the intensive medical therapy group had satisfactory blood glucose control, as compared to 37 and 42 percent in the two surgery groups.

The take-home message? Bariatric surgery was a significant improvement over regular care, or even intensive medical therapy, for both weight loss, and for amelioration of type 2 diabetes notes ACSH s Dr. Ruth Kava.

An accompanying editorial in the journal, by Drs. Paul Zimmet and George Alberti, observes that there is still much to be learned about the long-term effects of surgery on these patients; both of these studies included small numbers of patients followed over only a short time period, and surgery itself has some risks. Yet in light of these findings, the editorial proposes that bariatric surgery should not be seen as a last resort. Such procedures might well be considered earlier in the treatment of obese patients with type 2 diabetes.