Is Weight Loss Surgery The Answer For Diabetes?
With commentary by Anita P. Courcoulas MD, MPH, FACS, professor of surgery and director of minimally invasive bariatric & general surgery at the University of Pittsburgh Medical Center Is weight-loss surgery better than nutrition and physical activity alone for reversing type 2 diabetes? That controversial question has occupied researchers, doctors, insurers and people with diabetes for more than a decade. Now, a small yet well-designed study seems to have the answer: Surgery. University of Pittsburgh researchers randomly assigned 61 obese women and men with type 2 diabetes to receive gastric bypass surgery, an adjustable gastric band or an intensive lifestyle change program. Study volunteers were tracked closely for three years, as scientists monitored their weight, fasting blood sugar, A1c levels (a test of long-term blood sugar control) and use of insulin and other diabetes medications. The results: More weight (and fat) lost: Gastric bypass recipients lost an average of 25% of their body weight (and nearly 11% of their body fat), gastric band wearers dropped 15% of their weight (and 5.6% of their body fat) and lifestyle group members lost 5.7% of their weight and 3% of their body fat. People in the gastric bypass also saw their waist size shrink the most, an indicator that they’d lost the most visceral fat – the kind that packs around internal organs and contributes to blood sugar processing problems. Lower blood sugar: People in the gastric bypass group saw fasting blood sugar drop 66 mg/dL and their A1c levels fall 1.4%. In comparison, gastric band recipients got a 35-point reduction in fasting blood sugar and a 0.8% reduction in A1c levels. For the lifestyle-only group, fasting blood sugar fell an average of about 28 mg/dL but A1c levels rose slightly. Less d Continue reading >>
How Does Gastric Bypass Surgery Cure Type 2 Diabetes?
Gastric bypass surgery often improves the symptoms of type 2 diabetes, even before patients start to lose weight. Why? “What we found is that the secret for the cure of diabetes after gastric bypass lies in the intestine,” said Dr. Nicholas Stylopoulos, principal investigator at the Division of Endocrinology at Children's Hospital Boston and Boston Medical School, in an interview with Healthline. “The key message is that after gastric bypass the intestine becomes the most important tissue for glucose use and this decreases blood sugar levels.” His research was published last week in the journal Science. Doctors are hopeful they can find a way to mimic the processes that lead to improvements for type 2 diabetics after gastric bypass without actually doing the surgery. Small Intestine to the Rescue Here's how it works: After gastric bypass, which is a common weight loss solution for the severely obese, the small intestine spontaneously begins to produce a molecule called GLUT-1 that helps the body use glucose. “The quite amazing thing is that this is not present normally in the small intestine of adults, but only in the fetus,” said Dr. Erini Nestoridi, a research fellow in Stylopoulos' lab, in an interview with Healthline. “This happens most likely because the intestine has to work harder to do its job, for example to absorb the nutrients or move the food further down. Also, it may be that the mechanical stress of 'dumping' the food directly to the intestine, since the stomach is bypassed, contributes to these changes.” Although weight loss and improved diabetes symptoms go hand in hand, previous research has shown that gastric bypass surgery helps resolve the disease even before weight loss occurs. According to the U.S. Centers for Disease Control and Pr Continue reading >>
Unveiling The “magic” Of Diabetes Remission After Weight-loss Surgery
An extraordinary thing happens to some patients with type 2 diabetes who undergo weight-loss surgery: Within days of the procedure, they improve their insulin production and need fewer or no diabetes medications. Although it’s well established that losing weight, especially around the waistline, improves pancreas function and insulin sensitivity, it generally takes 6 months to a year after bariatric surgery before a patient sheds a substantial number of pounds. Bruce M. Wolfe, MD, professor of surgery at Oregon Health and Science University School of Medicine, recalled one “remarkable” case in which a patient who required 400 daily units of insulin prior to gastric bypass surgery needed none on the day she was discharged from the hospital. Continue reading >>
Bariatric Surgery For Type 2 Diabetes: Weighing The Impact For Obese Patients
Bariatric surgery for type 2 diabetes: Weighing the impact for obese patients SANGEETA R. KASHYAP, Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic; Sangeeta Kashyap, MD, Department of Endocrinology, F20, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195; [email protected] ; Philip Schauer, MD, Bariatric and Metabolic Institute, M61, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195; [email protected] aDr. Brethauer has received research support from Bard-Davol, honoraria from Coviden for teaching and speaking, and honoraria and fees from Ethicon Endosurgery for consulting and serving on advisory committees or review panels. bDr. Schauer has received honoraria, fees, or grants from Allergan, Bard-Davol, Barosense, Baxter, Cardinal/Snowden Pincer, Coviden, Ethicon Endosurgery, Gore, Surgical Excellence LLC, and Surgiquest for various work. See other articles in PMC that cite the published article. Obesity is a potent risk factor for the development and progression of type 2 diabetes, and weight loss is a key component of diabetes management. Bariatric surgery results in significant weight loss and remission of diabetes in most patients. After surgery, glycemic control is restored by a combination of enforced caloric restriction, enhanced insulin sensitivity, and increased insulin secretion. Evidence is mounting for the use of bariatric surgery to treat type 2 diabetes mellitus in patients whose body mass index (BMI) is 35 kg/m2 or higher. In obese patients who also have type 2 diabetes, bariatric surgery sends it into remission (defined as normoglycemic control without the need for diabetic medications) in more than three-fourths of cases, with higher rates with the Roux-en-Y gastric bypass procedure than with the laparoscopic adjustab Continue reading >>
Bariatric Surgery For Type 2 Diabetes Reversal: The Risks
The twin epidemics of obesity and type 2 diabetes are on the rise. From 1986 to 2000, the prevalence of BMI 30 kg/m2 doubled, whereas that of BMI >40 kg/m2 quadrupled, and even extreme obesity of BMI 50 kg/m2 increased fivefold (1). Of particular concern is the alarming increasing prevalence of obesity among children, suggesting that the epidemic will worsen (2). The impact of obesity on longevity has been well documented. In the world, over 2.5 million deaths annually can be attributed to obesity; in the U.S. alone over 400,000 deaths attributable to obesity occur per year—second only to those attributable to cigarette smoking. There is a direct relationship between increasing BMI and relative risk of dying prematurely, as evidenced in the Nurses’ Health Study with a 100% increase in relative risk as BMI increased from 19 to 32 kg/m2. Annual risk of death can be as high as 40-fold that of an age- and sex-matched nonobese cohort (3,4). The Framingham data revealed that for each pound gained between ages 30 and 42 years there was a 1% increased mortality within 26 years, and for each pound gained thereafter there was a 2% increased mortality. Only one in seven obese individuals will reach the U.S. life expectancy of 76.9 years. In the morbidly obese population, average life expectancy is reduced by 9 years in women and by 12 years in men. It has been over 10 years since the resolution of type 2 diabetes was observed as an additional outcome of surgical treatment of morbid obesity. Moreover, it has been shown unequivocally that diabetes-related morbidity and mortality have declined significantly postoperatively, and this improvement in diabetes control is long lasting. Bypass procedures, the Roux-en-Y gastric bypass (RYGBP) and the biliopancreatic diversion (BPD), are Continue reading >>
Bariatric Surgery For Diabetes
New guidelines last week recommended surgery as Type 2 diabetes treatment for people who are obese, including some who are mildly obese. Is “metabolic surgery” something you should consider? The guidelines were approved by the American Diabetes Association, the International Diabetes Federation, and 43 other medical groups around the world. They were published in the June issue of the journal Diabetes Care. If you are heavy and have an HbA1c of 7.0 or above, your doctor may soon advise you to have one of these surgeries. You will be told the surgery will lower your blood sugar and your weight, which usually happens. You may not be told the negative effects. How do you decide? When performed to manage diabetes, bariatric or weight-loss surgery is known as “metabolic surgery.” The term covers Roux-en-Y “gastric bypass” surgeries, which reduce your stomach to a small pouch and plug it into the middle of the small intestine. It also includes “sleeve gastrectomy,” in which the deep part of the stomach is removed and the rest stapled together into a sleeve shape. Wrapping a band around the stomach to shrink it (“gastric banding“) is also now considered metabolic surgery. There are other surgeries that restructure the bowel in different ways, which I’ll write about next week. Surgeons have been pleased to learn that their weight-loss operations also lower blood sugars, though they are working to fully understand how that happens. It’s probably not the weight loss. Often, the improvements in diabetes numbers come long before significant weight loss occurs. A conference in Rome in 2007 reported that people were getting off their diabetes medications and lowering their HbA1c scores after surgery. Eight years later, a follow-up conference in London decided Continue reading >>
The Role Of Bariatric Surgery To Treat Diabetes: Current Challenges And Perspectives
The role of bariatric surgery to treat diabetes: current challenges and perspectives 1 Carel W. le Roux ,2,3 and Alexander Kokkinos 1 1First Department of Propaedeutic Internal Medicine, Diabetes Centre, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece 1First Department of Propaedeutic Internal Medicine, Diabetes Centre, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece 2Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland 3Investigative Science, Imperial College London, London, UK 1First Department of Propaedeutic Internal Medicine, Diabetes Centre, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece 1First Department of Propaedeutic Internal Medicine, Diabetes Centre, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece 2Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland 3Investigative Science, Imperial College London, London, UK Chrysi Koliaki, Email: [email protected] . Received 2017 May 27; Accepted 2017 Aug 6. Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated. Bariatric surgery is emerging as a powerful weapon against severe Continue reading >>
Bariatric Surgery: American Diabetes Association
Bariatric surgery (Gastric Bypass or Laparoscopic Gastric Banding) is sometimes considered for adults with a body mass index (BMI) above 35 and type 2 diabetes, especially if the diabetes is difficult to control with lifestyle changes and medicines. Although small trials have shown benefits to blood glucose control in patients with type 2 diabetes and high BMI, there isn't enough evidence for people with BMIs lower than 35. There are two main types of bariatric surgery: Gastric bypass surgery: shrinks the stomach (from the size of a fist to that of a thumb) and shortens the path food takes through the small intestine. This limits the number of calories absorbed. This change is permanent. Laparoscopic Gastric Banding also known as Lap-banding: a belt is wrapped around the stomach. This belt cinches the stomach so that it will feel full with less food. This change can be adjusted or reversed if needed. Because bariatric surgery is not regarded as a cure, it is recommended that individuals who have undergone a bariatric procedure continue to have the regular screenings that are recommended for people with diabetes, whether or not their glucose levels have normalized. In addition, they need careful ongoing assessments of blood glucose control conducted by their health care provider, as those with normal blood glucose levels after surgery are at risk for a return of hyperglycemia. Continue reading >>
Bariatric Surgery: An Effective Treatment For Type 2 Diabetes
Bariatric Surgery: An Effective Treatment for Type 2 Diabetes Bariatric Surgery: An Effective Treatment for Type 2 Diabetes Safety of bariatric surgery is similar to that of commonly performed laparoscopic procedures, such as cholecystectomy or appendectomy. Type 2 diabetes and obesity, both significant contributors to death and disability, are among the most rapidly growing health problems in the world.1,2 Although there have been major advances in the pharmacologic treatment of diabetes, fewer than 10% to 50% of patients achieve the recommended targets for hemoglobin (Hb)A1c or cholesterol levels or blood pressure.2,3 In addition, 85% of patients with type 2 diabetes have a body mass index (BMI) consistent with overweight or obesity, an important cause of insulin resistance.4 However, few individuals with type 2 diabetes and obesity are able to achieve significant, sustained weight loss with diet and lifestyle measures alone.2 Physiologic Mechanisms for Improved Glycemic Control Bariatric, or metabolic, surgery is usually used for the treatment of severe obesity, but evidence also supports bariatric surgery as an effective treatment for type 2 diabetes in obese patients. Nearly 80% of patients with type 2 diabetes and obesity who undergo bariatric surgery achieve diabetes remission, compared with only 15% of those who achieve remission with intensive pharmaceutical and lifestyle interventions.1 The mechanism for improved glycemic control and remission of diabetes after bariatric surgery is still unclear due to multiple changes that occur in response to surgery, Judy Chen, MD, Assistant Professor of General Surgery specializing in bariatric and metabolic surgery at the University of Washington School of Medicine in Seattle, told Endocrinology Advisor. Dr Chen noted th Continue reading >>
How Weight Loss Surgery Helps Type 2 Diabetes
Weight loss surgery can make a big difference for people with type 2 diabetes. For some people, blood sugar levels get back to normal after surgery. Diabetes can be cured.That could mean you need less medication or none at all. Research shows improvements in type 2 diabetes after weight loss surgery. One long-term study tracked 400 people with type 2 diabetes. Six years after bariatric surgery, 62% showed no signs of diabetes. They also had better blood pressure, cholesterol, and triglyceride levels. In comparison, only 6% to 8% of people who took medicine, but didn’t have surgery, showed similar results. If you’re thinking about it, and you’re ready to make big changes to keep up the results, you’ll want to know if it’s right for you. First, your doctor will consider two things: Is your BMI 35 or higher? Have you tried to lose weight and keep it off without success? If so, he will give you a detailed checkup and ask you questions to see if you are physically and emotionally ready for the operation and the major changes you'll need to make. (You'll need to eat a lot less and make a healthy diet and exercise part of your life forever.) Depending on your particular case, other doctors may also get involved. For instance, if you have heart disease, your cardiologist would need to approve you for surgery. There are different kinds of operations. Some help you lose weight by shrinking the size of your stomach so you feel full after small meals. Others change the way your body absorbs calories, nutrients, and vitamins. Still others do both. Get to know what’s involved with each of these: 1. Gastric bypass (also called Roux-en-Y gastric bypass) The surgeon makes a small stomach pouch by dividing the top of the stomach from the rest of it. When you eat, food goes to Continue reading >>
Dear Doctor - Can Bariatric Surgery Treat Type 2 Diabetes? - Obesity Action Coalition
Answer provided by Lloyd Stegemann, MD, FASMBS To view a PDF version of this article, click here . Diabetes is a devastating problem worldwide. It has been estimated that as much as 8.3 percent of the worlds population has diabetes and this number is on the rise. As your weight goes up, so does your risk of developing type 2 diabetes (T2D). In fact, almost 25 percent of individuals who are affected by severe obesity (body mass index greater than 35) will carry a diagnosis of T2D. Uncontrolled diabetes leads to a host of long-term problems including heart attacks, strokes, kidney failure, blindness and the need for amputations. For many years, bariatric surgeons have known that bariatric surgery has a profound effect on T2D. It is not uncommon for our T2D patients to come off of all of their diabetic medications after bariatric surgery. Many primary care physicians (PCP), however, have been reluctant to advise bariatric surgery as the first line of treatment for their patients affected by severe obesity with T2D because of the lack of quality studies comparing the effectiveness of medical therapy versus surgical therapy for the treatment of T2D. Two recent studies that appeared in the New England Journal of Medicine were designed to help answer this question. In the first study, known as the STAMPEDE trial, 150 poorly controlled diabetic patients were divided randomly and equally into three groups. All of the patients in the study received intensive medical therapy including lifestyle counseling, weight management, frequent blood sugar monitoring, and diabetic medications. Fifty of the patients then continued with this intense medical therapy, 50 underwent a roux-en-y gastric bypass surgery, and the other 50 patients underwent a sleeve gastrectomy. All of the patients w Continue reading >>
Gastric Bypass Better Than Lifestyle Changes For Diabetes Control: Study | Everyday Health
Be sure to consult your doctor if you're considering gastric bypass surgery to better control your blood sugar. Lifestyle changes like fitting more activity into your day and eating more nutritious, high-fiber foods have long been recommended for people diagnosed with type 2 diabetes to aid in weight loss and blood sugar control. For people with type 2 diabetes who are obese , theres also the option of gastric bypass surgery. If you fall into the latter category, gastric bypass may indeed be a good choice: A randomized trial suggests that the procedure may be more effective for long-term weight loss than simply changing your diet or lifestyle. Published in the February 2018 issue of Diabetes Care , the study found that after three years, obese participants who underwent gastric bypass lost an average of nearly 55 pounds (lb) compared with those in the weight management group, who lost just 11 lb. The gastric bypass group also saw their A1C (a measurement of average blood sugar levels over two to three months) and cardiometabolic risk factors (like blood pressure and triglycerides) improve more, as well as quality-of-life factors like self-esteem. They were also able to use fewer diabetes, blood pressure, and cholesterol medications. RELATED: How to Lower Your A1C by Taking 5 Small Steps How Study Authors Carried Out the Research In the study, researchers used a specific type of bypass called Roux-en-Y gastric bypass (RYGB), which is a surgery done to reduce the size of the upper stomach. One group received the surgery, while the other took part in a medical diabetes- and weight-management program, wherein they adjusted their medications to help enhance weight loss, changed their diets, exercised, and took educational classes. Fewer than 10 percent of patients could kee Continue reading >>
Type 2 Diabetes: Why Bariatric Surgery Is Safer Option
Doctors typically consider bariatric surgery for those with a body mass index (BMI) above 40. But a recent study by Cleveland Clinic physicians suggests the threshold can be lower if you have type 2 diabetes. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy Its a good idea to consider having surgery to help you lose weight if you have diabetes and your BMI is higher than 30, says surgeon Ali Aminian, MD , one of the studys authors. Bariatric surgery may help reduce your blood sugar levels over the long term, he says. Hospitals set the guidelines decades ago when open surgery was the only option for a bariatric procedure. Now that doctors can perform the surgery through small incisions, its safer, Dr. Aminian says. We have high-quality data in patients with lower BMIs with diabetes that shows it would be a safe and very effective intervention for them, he says. Cleveland Clinic physicians analyzed 252 patients who had surgery at the hospital from 2004 to 2012. Most were overweight or obese, had high HbA1c levels and had diabetes for about a decade. All patients were taking insulin before surgery. Three-quarters of the patients had gastric bypass surgery . The rest had a sleeve gastrectomy, where the stomach is dramatically reduced in size. Doctors followed up with the surgical patients five to 12 years later and found: 44 percent had long-term glycemic control without insulin. 59 percent met the American Diabetes Association glycemic target (HbA1c less than 7 percent). The patients also lowered their BMI, blood pressure and cholesterol levels. The beta cells in the pancreas store and release insulin. Over time, as diabetes progresses, the cells Continue reading >>
Can Bariatric Surgery Cure Type 2 Diabetes?
Can Bariatric Surgery Cure Type 2 Diabetes? More and more studies claim that the answer may be "yes"; in many cases, bariatric surgery is an effective cure for those suffering from type 2 diabetes. To be clear, diabetes is not well understood and medical science cannot claim a permanent cure. The goal is to put diabetes in remission. Remission means a return to normal blood sugar levels and no need for diabetes medications. With glucose at normal levels, the progression of diabetic complications is halted, thus giving the body a chance to repair the damage. In other words, remission means that you are presently "cured" and will remain so, unless the factors causing the disease return to a degree sufficient to cause a relapse. So, the correct question is, does bariatric surgery cause type 2 diabetes to go into remission? And, in many cases, the answer is a resounding yes. How does bariatric surgery cure Type 2 diabetes? We know that bariatric surgery puts type 2 diabetes into remission; what we dont know is how it does it. It's clear that healthy weight loss plays a significant role in reducing blood sugar levels in Type 2 diabetics, and bariatric surgery has been proven to be the most effective way for obese patients to lose significant body weight. But, there are additional factors at work. Many see an instant reversal of their diabetes immediately after gastric bypass surgery or gastric sleeve surgery before they lose any weight. This is what science doesn't fully understand. One theory suggests that bypassing or removing part of the stomach immediately impacts the way glucose is processed in the digestive system. Another claims that by shunting food directly to the lower intestine, a substance called glucagon-like peptide 1 (GLP-1) is stimulated, which can increase Continue reading >>
Bariatric Surgery For Type 2 Diabetes
Santiago Horgan, MD, briefly describes weight-loss surgery for resolution of type 2 diabetes. Gastric sleeve (sleeve gastrectomy) and gastric bypass are excellent options for patients with type 2 diabetes or other obesity-related conditions. Obesity if the primary cause for type 2 diabetes. Type 2 diabetes can lead to health problems including stroke, blindness, kidney failure, heart disease, depression, neuropathy and increased cancer risk. Type 2 diabetes can reduce life expectancy up to 14 years. Lifestyle intervention is firstline therapy for type 2 diabetes. This includes If you are obese and have type 2 diabetes weight-loss (bariatric) surgery can have a profoundly positive effect on your health. Weight-loss surgery can reverse diabetes and reduce or eliminate the need for diabetes medications. Uncontrolled high blood sugar and diabetes is dangerous and increases your risk of many serious health problems, including: Diabetic nerve disease, which can lead to limb amputation Continue reading >>
