A recent study that compared the effectiveness of conventional approach for treating Type 2 diabetesdefine over weight-loss surgery shows the latter works much better.
Sixty patients were studied. They had an average age of 47; all were obese and were randomly assigned to receive either surgery or medication. Nearly 73% of those who had surgery showed no recurrence of diabetes meaning all signs of the disease vanished. In comparison, the remission rate was only 13% in the group that received conventional treatment, which included intensive counselling on lifestyle changes covering diet and exercise for weight loss and diabetes medication like insulindefine, metformin and other drugs, wherever necessary.
Surgery worked better because this group of patients lost much more weight at 20.7% of their body weight than the medically treated group who lost only 1.7% of their body weight, on average. Obesity is one of the important factors in Type 2 diabetes. Patients can often lower the severity of the disease or recover fully, by losing about 10% of their body weight. While many people can successfully lose that much weight, they find difficulty in staying so without surgery.
However, not all patients with Type 2 diabetes could demonstrate similar results because the people in the study had mild diabetes of recent onset. They had had the disease for only about two years. Severe and longstanding diabetes may not be reversible irrespective of the amount of weight lost.
Adjustable gastricdefine banding was the technique adopted for the study. It involves putting in small slits and looping a band around the top of the stomach to cinch it into a small pouch. People would eat less and yet feel full. There are other weight-loss operations. These are more extreme and involve cutting or stapling the stomach and rearranging the small intestinedefine. Nearly 25% to 30% of the 205,000 weight-loss operations performed in the United States last year used gastric banding.
For many years, doctors have known that Type 2 diabetes would remit after weight-loss surgery. However, this study has provided scientific evidence about the efficacy of the technique over traditional medical treatment in similar groups of patients.
Type 2 diabetes is a chronic condition that has significant impact on patients’ lives. The incidence of diabetes is rising and growing concern both in the United States and abroad has prompted new research into the cause, development and treatment of the disease. Other complications like heart attacks, blindness, kidney failure and amputation make such research more imperative in our times.
In this light, the study has importance on evolving surgery as a potential cure for diabetes. The term ‘bariatric surgery’ now includes the suitability for treating metabolic diseases like diabetes.
Dr John Dixon, an obesity researcher at Monash University in Melbourne, Australia, is the lead author of the study. The study and an editorial about it are being published Wednesday in the Journal of the American Medical Association. He hoped diabetes surgery would become common in a few years. The editorial accompanying the study stated surgical intervention for treatment of diabetes could be the most significant step since the discovery of insulin.
While scientists have expressed confidence that minimally invasive surgery could be an acceptable method to treat diabetes, there was need for caution in adopting the approach across-the-board.
According to the American Diabetes Association, 19 million people in the United States have Type 2 diabetes, and nearly 54 million are in the ‘pre-diabetic’ phase, that is abnormalities in their blood sugar increase their risk. Diabetes is the fifth largest killer, about 73,000 people succumbing to it every year. The disease is growing by about 8% a year.
The rise in diabetes and the associated complications are directly attributed to the growing epidemic of obesity in the country. Nearly 43% of adult Americans did not have adequate physical exercise. Coupled with poor diet habits this means their Body Mass Indexdefine (BMI) is well over the 25, the threshold for ideal weight. A BMI over 25 is considered overweight and over 30 is obese. Patients in the study had BMI between 30 and 40.
Since 1991, weight-loss surgery has been generally recommended for people with BMI of 40 or more although the cut off is 35 for cases with Type 2 diabetes. In this study, 13 people had BMI under 35.
Many private insurers refuse to cover weight-loss surgery. In the US, banding costs $17,000 and the other bariatric operations $25,000.
Doctors are also unanimous that guidelines such as those by the National Institutes of Health need to be revised so that patients with lower BMI could be offered surgery as an option early enough to reverse the disease.
Other weight-loss operations that rearranged the small intestine had faster and more powerful effects on diabetes than did the banding, because they changed the levels of certain gut hormonesdefine that greatly improve the body’s ability to control blood sugar, weight and lipid levels in the bloodstream. These operations, and the hormones responsible, have become the focus of intense research.
Allergan Health, the company that makes the gastric bands offered Dr. Dixon research grants and speakers’ fees through a grant to the university. But he claimed the company had no influence on the design of the study, the data or the report. Allergan and other companies had offered travel grants to the editorial writers to attend a conference on diabetes surgery in Rome.
Joined: 2008-01-21