Weight Loss Surgery

With nearly 26 million Americans either being treated for type 2 diabetes or living undiagnosed, doctors are seeking more effective methods to treat the disease, which has reached an epidemic. In light of two new studies published in The New England Journal of Medicine, they may soon have more options.

In each study, two groups of patients with uncontrolled type 2 diabetes were each treated differently one group was given a type of bariatric surgery to reduce stomach size, which ultimately reduced the amount of food they could eat, and the other was treated medically with a variety of drugs including insulin. In the two years following the procedures, the surgical groups fared much better in terms of overall remission rates.

One study compared the remission rates between groups who underwent one of two types of surgery with another group that was treated only with medications. The second study compared two types of surgery with more intensive medical supervision, including medications. In both studies, those who had surgery fared largely better than those who did not, though remission rates (75 and 95 percent in one study, and 42 and 37 percent in the other) had improved slightly (12 percent) under intensely supervised medical care. There was no remission in the group treated only with medication.

“We know the procedures work. They have been around for a long time,” says Dr. Gerald Bernstein, attending physician and director of the Diabetes Management Program of the Friedman Diabetes Institute at Beth Israel Medical Center.

“We must now reassess the metabolic changes that occur after surgery beyond what makes food less accessible, such as the complexity of the gut hormones [and their affect on the body’s levels of sugars and fats]. But we know that millions of people who have chronic, uncontrolled type 2 diabetes could benefit from bariatric procedures,” he says. The hope is that learning more about how uncontrolled type 2 diabetes is reversed through surgery may lead to the development of new treatments and medications. “We can find out what medications can be used to accomplish the same beneficial changes,” he continues, “but the recent studies are part of a continued approbation that the procedures work.”

According to a 2010 evaluation by the American Diabetes Association of more than 600 past studies, bariatric surgery is about 78 percent effective at either controlling the disease or sending it into complete remission. Other health benefits often come along after surgery, too, such as reduced blood pressure and the harmful effects of heart disease. 

At the same time, patients must be fully aware of surgical risks, such as the potential for infection, possible malnutrition, or even the need for revision surgery. A careful surgical evaluation must be discussed with your doctor.

Some evidence in both studies suggests that other determining factors, such as a person’s weight prior to surgery, might influence its success rate and whether or not his or her diabetes will go into remission as a result.

Following the publication of the studies, the Endocrine Society released a statement to doctors urging caution when considering who might make the best surgical candidates. It noted that successful outcomes are determined partly by “body mass index (B.M.I.) and age, the number of years a person has had diabetes, as well as an [accurate] assessment of [his or her] ability to comply with the long-term lifestyle changes that are required to maximize success and minimize complications.” The American Diabetes Association currently recommends surgery for diabetic patients who have a B.M.I. of 35 or more.