Gastric Bypass for Diabetes

Maintaining a balanced diet and exercising regularly can mitigate some of the effects of type 2 diabetes. And bariatric, or weight loss, surgery can also be a big help in shedding the extra pounds that make type 2 diabetes difficult to live with. The medical community is beginning to realize just how effective such surgery can be in addition to traditional forms of weight loss therapy.

A study published today in The Journal of the American Medical Association found that mild to moderately obese patients with type 2 diabetes were able to improve their health significantly by including gastric bypass surgery in their weight loss plan, along with intensive medical management. Patients who underwent the surgery not only lost more weight, but also experienced a greater likelihood of improved blood glucose regulation, LDL cholesterol and systolic blood pressure levels, and other markers of treatment as recommended by the American Diabetes Association.

The procedure has its risks, but the largely positive outcomes make a solid argument for incorporating bariatric surgery into a healthy lifestyle plan.

In a randomized trial that lasted for 12 months, half of a group of 120 overweight patients were assigned to undergo gastric bypass surgery to compare the procedure with certain lifestyle and medical management choices to control risk factors for type 2 diabetes. The remaining patients followed the Look AHEAD intensive lifestyle-medical management protocol for treating diabetes in obese patients.

Overall, patients in the gastric bypass group lost a higher percent of their initial body weight, used fewer medications to manage their diabetes, and experienced improved levels of certain metabolic risk factors for diabetes versus the lifestyle management group.

Why Not Just Exercise?

Exercise will always be an important factor in your health and well being, whether you have diabetes or not. But bariatric surgery can enhance the positive effects of exercise. And because it makes the stomach smaller, it can also be a more permanent method of weight control. As the study authors reported, “sustained weight loss through lifestyle modification improves diabetes control, but this is difficult to achieve and maintain over time.”

The researchers note that other studies relating to bariatric surgery and type 2 diabetes, such as the Swedish Obesity Subjects Study, also found greater weight loss and a reduced incidence of type 2 diabetes among surgical patients. However, the researchers point out that many of these randomized trials had limitations, including patient participation and the intensity of the lifestyle-medical interventions.

The current study makes a strong case for bariatric surgery for people living with type 2 diabetes, but further research must be done to make a definitive argument about the role of this surgery in the overall health of diabetics.

“Whether the surgical advantage remains when compared with optimal medical and lifestyle treatment is unknown,” the authors wrote.

How Safe Is Bariatric Surgery?

The report states that the risk of death from bariatric surgery is between 0.1 and one percent, but other, less life-threatening side effects are more common. There were four perioperative complications and six late-postoperative complications in this study group alone, and the gastric bypass group was more nutritionally deficient than the lifestyle-medical management group. However, these risks must be weighed against the outcomes of a successful, and potentially effective, bariatric procedure.

“The merit of gastric bypass treatment of moderately obese patients with type 2 diabetes depends on whether potential benefits make risks acceptable,” the researchers said. “Bariatric surgery can result in dramatic improvements in weight loss and diabetes control in moderately obese patients with type 2 diabetes who are not successful with lifestyle changes or medical management. The benefits of applying bariatric surgery must be weighed against the risk of serious adverse events.”

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