In findings that promise radical changes in the care of the 20 million U.S. patients with Type 2 diabetes, two new clinical trials have shown that weight-loss surgery brings about dramatically greater improvement of blood sugar control in obese diabetics than standard diabetes care.
In both studies, even rigorously supervised regimens of diet, exercise and medications failed to bring blood sugar under good control after a year or more. In contrast, two teams of researchers one in Italy, the other in the United States reported that surgical procedures to reduce the size and sometimes the placement of the stomach often allowed subjects to discontinue diabetes medications within weeks.
Both studies were published online Monday in the New England Journal of Medicine. One of them, by researchers at the Cleveland Clinic and Harvard University, was presented Monday at the American College of Cardiology's annual meeting in Chicago.
In an accompanying editorial in the journal, diabetes specialists Paul Zimmet and K. George M.M. Alberti wrote that although surgical weight-loss procedures were "not yet" a panacea for the worldwide epidemic of Type 2 diabetes, the new research "suggests they should not be seen as a last resort."
"Such procedures might well be considered earlier in the treatment of obese patients with Type 2 diabetes," Zimmet and Alberti wrote. Zimmet is a specialist at the Baker IDI Heart and Diabetes Institute in Melbourne, Australia, and Alberti is at King's College in London.
"Now we know that treating diabetes can and should be a primary reason for doing this surgery," said Dr. Lee M. Kaplan, director of the Massachusetts General Hospital Weight Center. Such surgery should not be the first line of treatment, Kaplan said, but it should become a fallback for patients whose blood sugar control remains poor despite medications and lifestyle changes.
"We ought to be using it more," he said.
Both studies examined patients who had undergone one of three bariatric surgery procedures: biliopancreatic diversion, Roux-en-Y gastric bypass or sleeve gastrectomy. In addition to improved blood sugar control, all experienced significantly greater weight loss than those on standard drug treatment.
Both studies also reported that subjects who had surgery saw more improvement in some, though not all, cholesterol measures than those on standard diabetes therapy.
In general, the studies found that the scale of improvements in patients' metabolic function and weight loss tracked the degree to which the surgical procedures reshaped the gastrointestinal system. Biliopancreatic diversion, the most radical of the operations, appeared to produce the most radical improvements, followed by Roux-en-Y bypass and sleeve gastrectomy.
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Weight-loss surgery effective against diabetes, studies show
