Weight-Loss Surgery May Beat Diet, Exercise as Type 2 Diabetes Treatment

After procedure, many patients no longer need medications, researchers find

Wednesday, July 1, 2015

WEDNESDAY, July 1, 2015 (HealthDay News) -- In a small study of obese patients, weight-loss surgery was better at keeping type 2 diabetes at bay than diet and exercise alone, researchers report.

In fact, three years after weight-loss surgery, more than two-thirds of those who had a procedure called Roux-en-Y gastric bypass to shrink their stomach didn't need any diabetes medications. And one-third of the people who chose a procedure called adjustable gastric banding no longer needed diabetes medications three years after surgery, the study found.

"Surgical treatments show promise for durable, longer-term, type 2 diabetes control in people with obesity," said lead researcher Dr. Anita Courcoulas, a professor of surgery at the University of Pittsburgh Medical Center.

The report was published July 1 online in JAMA Surgery.

The researchers recruited 61 obese patients with type 2 diabetes for the study. They were between the ages of 25 and 55 years old. The researchers randomly assigned the study volunteers to either an intensive weight-loss program for one year followed by a less intensive program for two years, or weight-loss surgery. Some patients had a Roux-en-Y gastric bypass and others had adjustable gastric banding.

Roux-en-Y gastric bypass reduces the size of the stomach to a small pouch -- about the size of an egg -- which reduces the amount of food you can eat. Adjustable gastric banding restricts the size of the opening to the stomach, also decreasing the amount of food you can eat.

In terms of type 2 diabetes, researchers found there was more improvement in the surgical groups than in the lifestyle-only treatment group. Forty percent of Roux-en-Y gastric bypass and 29 percent of the adjustable gastric banding patients achieved complete or partial remission of their diabetes at three years, Courcoulas said. No remission was seen in the nonsurgical group.

Moreover, people who had the Roux-en-Y gastric bypass lost 25 percent of their starting weight, adjustable gastric banding patients lost 15 percent, and patients who took part only in the diet and exercise program lost just under 6 percent of their starting weight at three years, Courcoulas noted.

"Our study provides evidence that after three years, surgical treatments are better than lifestyle modification alone to treat type 2 diabetes," Courcoulas said.

The cost of weight-loss surgery varies, but the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) estimates the cost is generally between $20,000 and $25,000. Insurance coverage for the procedure depends on the insurance company.

The risks associated with these procedures are similar to those of other surgeries. These can include bleeding, infection and blood clots that can travel to the lungs, according to NIDDK.

Dr. Joel Zonszein, director of the clinical diabetes center at Montefiore Medical Center in New York City, said that after these procedures patients see their diabetes go away, but over time it is likely to return.

When diabetes returns, it has to be treated. "But patients need fewer medications and are easier to treat," he said.

Zonszein said weight-loss surgery can be particularly effective for younger obese patients for whom diabetes medications aren't working well.

"For these young people, I do recommend bariatric surgery and we are using it more and more," he said. "It's not a bad choice for young people with aggressive disease."

For middle-aged and older patients, Zonszein said he prefers to control their diabetes with medications.

SOURCES: Anita Courcoulas, M.D., M.P.H., professor, surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.; Joel Zonszein, M.D., director, clinical diabetes center, Montefiore Medical Center, New York City; July 1, 2015, JAMA Surgery

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