According to new research, weight-loss surgery is reversing and possibly curing diabetes and doctors are recommending the operation should be offered to diabetics sooner and not just as a last resort.
Two studies done in the United States, released in late March, compare stomach-reducing operations to medicines alone to treat “diabesity”, the term coined for Type 2 diabetes brought on by obesity.
Both studies found that surgery helped patients achieve normal blood-sugar levels than medicines alone did.
According to the study results, some people stopped taking insulin as soon as three days after their operations and their cholesterol and other heart risk factors also greatly improved.
In one study, most of the surgery patients were able to stop all diabetes drugs and have their disease stay in remission for at least two years. None of those treated with medicines alone could do that.
In Cayman, more people are turning to bariatric surgery for weight loss and to help combat their diabetes.
One diabetic woman in her mid 50s, who travelled to Costa Rica from Cayman to undergo bariatric surgery last October, said she did not have to go back on her diabetes medication following her operation.
“I had to cease taking my diabetes and high blood pressure medications two days before the operation and I have not gone back on the diabetes medications. I still check my blood sugar levels,” she said, adding that, so far, her diabetes seems in remission. She still takes some medication for high blood pressure, but not every day, as she’d had to do before the operation.
Because of problems with her knees and neck, she has not been able to exercise much since – or before – the operation, but even without exercise, her blood sugar levels remain normal.
She is also eating what she wants, including ice cream and cake, albeit in small amounts, following her gastric sleeve procedure, which removed 80 per cent of her stomach.
Starting out at 202 pounds, she has lost 42 pounds. She said she is one of the lighter patients her surgeon had operated on, as the gastric sleeve procedure is usually done on extremely obese patients. However, this patient, who has asked not to be named, said she was considered a candidate for the surgery due to her age and her declining health.
“I’d been that weight for 12 to 15 years. I had high blood pressure, high cholesterol… I could not even do light exercise, like swimming, because of surgeries on my knees and neck… It had become harder and harder for me to lose weight,” she said.
She was diagnosed with diabetes two years ago. Her mother and grandmother had also had the disease.
The disappearance of diabetes so soon after bariatric surgery seems to indicates that the surgery itself, and not simply the subsequent loss of weight and change in diet puts the disease into remission.
Food makes the stomach produce hormones to spur insulin, so trimming away part of it surgically may affect those hormones, doctors believe.
Weight-loss surgery “has proven to be a very appropriate and excellent treatment for diabetes,” said one study co-leader, Dr. Francesco Rubino, chief of diabetes surgery at New York-Presbyterian Hospital/Weill Cornell Medical Center. “The most proper name for the surgery would be diabetes surgery.”
The studies were published online by the New England Journal of Medicine, and the larger one was presented recently at an American College of Cardiology conference in Chicago.
For patients in Cayman, most in the private sector must pay for the surgery themselves, as private insurance companies tend not to cover the operations. The government’s Cayman Islands National Insurance Company, however, covers bariatric surgery in certain extreme cases.
The new studies tested permanent weight-loss surgery in people with longtime, severe diabetes.
At the Cleveland Clinic, Dr. Philip Schauer studied 150 people given one of two types of surgery plus standard medicines or a third group given medicines alone. Their A1c levels — the key blood-sugar measure — were over 9 on average at the start. A healthy A1c is 6 or below.
One year after treatment began, only 12 per cent of those treated with medicines alone were at that healthy level, versus 42 per cent and 37 per cent of the two groups given surgery.
Use of medicines for high cholesterol and other heart risks dropped among those in the surgery groups but rose in the group on medicines alone.
“Every single one of the bypass patients who got to 6 or less got there without the need for any diabetes medicines. Almost half of them were on insulin at the start. That’s pretty amazing,” said a study co-leader, Dr. Steven Nissen, the Cleveland Clinic’s cardiovascular chief.
An obesity surgery equipment company sponsored the study, and some of the researchers are paid consultants; the federal government also contributed grant support.
The second study was led by Dr. Geltrude Mingrone at the Catholic University in Rome, with Rubino from New York. It involved 60 patients given one of two types of surgery or medicines alone. The researchers set as their goal an A1c under 6.5 — the level at which someone is considered to have diabetes.
Two years later, 95 per cent and 75 per cent of the two surgery groups achieved and maintained the target blood-sugar levels without any diabetes drugs. None of those in the medicine-alone group did.
There were no deaths from surgery and only a few complications. Four patients in the Cleveland study needed second surgeries, and two in the Italian study needed hernia operations. Doctors note that uncontrolled diabetes has complications, too — many patients wind up on dialysis when their kidneys fail, and some need transplants.
An adult who has a body mass index (a calculation based on height and weight) of 30 or more is considered obese. That’s 203 pounds or more for a 5ft 9in-tall man, for example.
Dr. Alvin Powers, director of the Vanderbilt University diabetes centre, said the results are very encouraging for people like those in these studies — very obese, with diabetes that can’t be controlled through less drastic means.
“We still don’t know the long-term outcomes of these surgeries” and whether the benefits will last for more than a few years, he said.
Others were more positive.
The studies “are likely to have a major effect on future diabetes treatment,” two diabetes experts from Australia, Dr. Paul Zimmet and George Alberti, wrote in an editorial in the medical journal. Surgery “should not be seen as a last resort” and should be considered earlier in treating obese people with diabetes, they wrote.
Benefits and risks of Weight Loss Surgery
Weight loss surgery is a serious undertaking. Before making a decision, talk to your doctor about the following benefits and risks.
Weight loss: Immediately following surgery, most patients lose weight rapidly and continue to do so until 18 to 24 months after the procedure. Although most patients then start to regain some of their lost weight, few regain it all.
Obesity-related conditions improve: For example, in one study, blood sugar levels of most obese patients with diabetes returned to normal after surgery. Nearly all patients whose blood sugar levels did not return to normal were older or had diabetes for a long time.
Risks and Side Effects
Vomiting: This is a common risk of restrictive surgery caused by the small stomach being overly stretched by food particles that have not been chewed well.
“Dumping syndrome:” Caused by malabsorptive surgery, this is when stomach contents move too rapidly through the small intestine. Symptoms include nausea, weakness, sweating, faintness and, occasionally, diarrhea after eating, as well as the inability to eat sweets without becoming extremely weak.
Nutritional deficiencies: Patients who have weight loss surgery may develop nutritional deficiencies such as aneThe Associated Press contributed to this article. mia, osteoporosis, and metabolic bone disease. These deficiencies can be avoided if vitamin and mineral intakes are maintained.
Complications: Some patients who have weight loss operations require follow-up operations to correct complications. Complications can include abdominal hernias, infections, breakdown of the staple line (used to make the stomach smaller), and stretched stomach outlets (when the stomach returns to its normal size).
Gallstones: More than one-third of obese patients who have gastric surgery develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. During rapid or substantial weight loss a person’s risk of developing gallstones increases. Sometimes this can be prevented by taking supplemental bile salts for the first six months after surgery.
Need to temporarily avoid pregnancy: Women of childbearing age should avoid pregnancy until their weight becomes stable because rapid weight loss and nutritional deficiencies can harm a developing fetus.
Side effects: These include nausea, vomiting, bloating, diarrhea, excessive sweating, increased gas, and dizziness.
Lifestyle changes: Patients with extensive bypasses of the normal digestive process require not only close monitoring, but also life-long diet and exercise modifications and vitamin and mineral supplementation.
The Associated Press contributed to this article.