Weight loss surgery may cure obese diabetics: study

Reuters, Friday 24 Jun 2011

Most obese people with diabetes will be cured of it by weight loss surgery, with gastric bypass surgery allowing more than 80 percent of patients to come off their diabetes medication, according to a study.

The report in Archives of Surgery concerned a review of earlier studies led by Rick Meijer, at the Institute for Cardiovascular Research at Vrije Universiteit in Amsterdam, who said the findings exceeded what was possible with more conventional diabetes treatments.

"In standard practice, only a very minor group of individuals with an iron will can lose enough weight to be cured from type 2 diabetes mellitus," Meijer said in an email to Reuters Health, referring to the most common type of diabetes.

Meijer and his colleagues pooled data from nine studies of diabetics who underwent either a gastric bypass -- which makes the stomach smaller and allows food to bypass part of the small intestine -- or gastric band surgery, in which the capacity of the stomach is reduced by using an adjustable band.

Eight of the studies included between 23 and 177 patients, while the last one traced 82,000 people. Each followed patients for at least a year.

After gastric bypass, 83 percent of patients could stop taking their diabetes medications, some within days of the surgery. After gastric banding, 62 percent could stop.

"Surgery ought to be considered front line therapy for diabetes among obese people," said Jon Gould, who heads the weight loss surgery program at the University of Wisconsin and was not involved in the study.

Meijer said about 90 percent of cases of diabetes are due to excessive weight, though not all diabetics would be eligible for the weight loss surgery.

It's also unclear how long surgery's impact on diabetes can last. One study included in the review found that 10 years after surgery, just one third of people whose diabetes had abated still had good control of their blood sugar.

Surgery of course has the potential for complications that wouldn't occur with drugs.

One study followed patients up to a month after surgery found that 7 percent experienced some problems, mainly minor wound infections. But massive bleeding, kidney failure and other serious complications occurred in more than 2 percent of patients.

Other side effects include nausea and some food intolerance, with some patients also gaining weight back over time.

Gould said the initial cost of the surgery, compared to the extended costs of diabetes care and other health effects of being obese, can be recouped after 18 months to two years.

"It would be a huge upfront cost, but looking at this from the bigger picture, I think if we can cure instead of manage the complications, we will save money in the long run," he told Reuters Health. 

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