Bariatric surgery, lifestyle changes can control Type II diabetes

Dr. Courcoulas and team concluded that weight loss surgery is “superior to lifestyle intervention alone for the remission of type 2 diabetes in obese individuals, including those with a BMI between 30 and 35”. None of the lifestyle treatment group experienced remission.

In an accompanying editorial, Michel Gagner, MD, FRCSC, FASMBS, of Florida global University, Miami, wrote: “We should consider the use of bariatric (metabolic) surgery in all severely obese patients with [type 2 diabetes] and start a mass treatment, similar to what was done with coronary artery bypass graft more than 50 years ago”.

The lead author, Anita Courcoulas, chief of minimally invasive bariatric and general surgery at UPMC, said that previous studies have showed that the surgery has the likelihood of improving diabetes, but the latest has proved that it has positive effects lasting as long as three years.

In their study, the team recruited 62 type 2 diabetes patients, between 25 and 55 years old, and asked them to participate in an intensive weight-loss program for an entire year followed by a less intensive one for two more years, or undergo surgery for weight loss.

[The study findings are] reminiscent of the Swedish Obesity Study, a nonrandomized study of 1,658 obese patients who underwent bariatric surgery and 1,771 obese matched controls.

40 per cent of those who underwent RYGB, and 29 per cent who had LABG achieved remission from type 2 diabetes. In comparison, no one in the group who received intensive lifestyle intervention resolved their diabetes. No remission was seen in the nonsurgical group. “These results contribute to addressing questions about the relative efficacy of different surgical vs. nonsurgical treatments for [type 2 diabetes] in lower BMI individuals”. Insurance coverage for the procedure depends on the insurance company. Weight loss is achieved by reducing the size of the stomach with a gastric band, through the removal of a portion of the stomach or by rerouting the small intestine to a small stomach pouch.

This research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases and the Magee-Womens Hospital of the University of Pittsburgh Medical Center.

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. Patients who were treated with weight loss surgery will need “fewer medications and are easier to treat” in the future. Now, a new study suggests that these surgical approaches may even be more effective at eliminating the disease than the tried-and-true methods of lifestyle intervention – in other words, diet and exercise.

If surgery is more successful for these patients, which surgery should be done?