Type 2 Remission
Obesity Surgery Can Put Type 2 Diabetes In Remission
OBESITY SURGERY is an increasingly popular weight-loss method.
Several kinds of surgeries exist; all reduce the size of the stomach
so that it holds much less food. Some surgeries also keep the body
from absorbing food well. As a result, the person takes in fewer
calories and loses weight.
People with type 2 diabetes get an important additional benefit, a
review has found. Blood glucose levels return to normal in three-
quarters of people with type 2 diabetes who have obesity surgery.
The goal of the review, which was published in the Oct. 13, 2004,
issue of the Journal of the American Medical Association, was to
examine past studies of obesity surgery to determine its effects on
four obesity-related conditions: type 2 diabetes, high blood
pressure, lipid abnormalities (such as high cholesterol), and
obstructive sleep apnea (a condition in which people wake repeatedly
during the night because they stop breathing).
The researchers searched several electronic databases for studies of
obesity surgery that included 10 or more people and followed them for
30 days or more. To be included in the analysis, studies had to
contain information on at least one of the four obesity-related
conditions. After several stages of winnowing, 136 studies that had
included 22,094 people remained. Only five studies were randomized
controlled trials, the most rigorous kind of study. The researchers
then performed a metaanalysis, which means they combined similar data
from different studies to create, in effect, one gigantic study.
The researchers looked at each medical condition to see whether it
improved or resolved after stomach surgery. "Resolved" meant the
condition disappeared or no longer required treatment. The
researchers considered diabetes "resolved" if the person was able to
stop all diabetes medicines and still have normal blood glucose
levels.
The researchers found that overall, people who had obesity surgery
lost an average of 61.2 percent of their excess weight. Different
kinds of surgery produced different amounts of weight loss, but no
method included in the study produced an average excess weight loss
of less than 47.5 percent.
In studies that reported on people whose type 2 was resolved, 76.8
percent (of 1,846 people) experienced resolution of their disease. In
studies that reported improvement results, more than 85 percent (of
485 people) saw improvement or resolution of their type 2 diabetes.
Researchers were able to narrow down type 2 resolution rates for
specific kinds of stomach surgery. Among those who received gastric
banding, 47.8 percent experienced resolution. The resolution rate was
68.2 percent for those who received gastroplasty; 83.8 percent for
those who received gastric bypass (such as Roux-en-Y); and 97.9
percent for those who received biliopancreatic diversion and duodenal
switch procedures. Improvement rates also varied, but were never less
than 80 percent.
Cholesterol levels, triglyceride levels, blood pressure, and sleep
apnea improved significantly as well, with at least three- quarters
of the participants seeing benefits. As with diabetes, improvement
rates varied among different methods.
The researchers concluded that stomach surgery in obese people
reverses, eliminates, or substantially improves several obesity-
related conditions, including diabetes. Only about 15 percent of
people with diabetes saw no improvement in their blood glucose
levels. Often, people’s blood glucose levels returned to normal
within a few days of surgery and stayed there. The researchers expect
that these changes should markedly increase the life expectancy of
many of the study’s participants.
Choosing to have stomach surgery is a drastic step that deserves
careful thought and detailed research into surgeons and techniques.
It’s painful and can have complications, and some insurance companies
do not cover it. One’s diet is forever limited. However, it is the
most effective treatment known for type 2 diabetes and can help with
other conditions such as high blood pressure that many people with
diabetes have.
Only about 15 percent of people with diabetes saw no improvement in
their blood glucose levels.
Shauna S. Roberts, PhD, is a science writer from New Orleans, La.
Copyright American Diabetes Association Jun 2005
Published: 2005/06/02 09:00:18 CDT