Can Diabetes Be Surgically Cured?
Long-Term Metabolic Effects of Bariatric Surgery in Obese Patients with Type 2 Diabetes Mellitus *Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH Department of Surgery, Loyola University, Chicago, IL Reprints: Stacy A. Brethauer, MD, Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH 44195. [email protected] The publisher's final edited version of this article is available at Ann Surg See commentary " Diabetes: Bariatric surgery for T2DM--cure, or remission and relapse? " in Nat Rev Endocrinol, volume 10 onpage8. See other articles in PMC that cite the published article. Evaluate the long-term effects of bariatric surgery on type 2 diabetes (T2DM) remission and metabolic risk factors. Although the impressive antidiabetic effects of bariatric surgery have been shown in short- and medium-term studies, the durability of these effects is uncertain. Specifically, long-term remission rates following bariatric surgery are largely unknown. Clinical outcomes of 217 patients with T2DM who underwent bariatric surgery between 2004 and 2007 and had at least 5-year follow-up were assessed. Complete remission was defined as glycated hemoglobin (A1C) less than 6% and fasting blood glucose (FBG) less than 100 mg/dL off diabetic medications. Changes in other metabolic comorbidities, including hypertension, dyslipidemia, and diabetic nephropathy, were assessed. At a median follow-up of 6 years (range: 59) after surgery (Roux-en-Y gastric bypass, n = 162; gastric banding, n = 32; sleeve gastrectomy, n = 23), a mean excess weight loss (EWL) of 55% was associated with mean reductions in A1C from 7.5% 1.5% to 6.5% 1.2% (P < 0.001) and FBG from 155.9 59.5 mg/dL to 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 >>
Why The New Surgical Cure For Diabetes Will Fail!
Why the New Surgical Cure for Diabetes Will Fail! Why the New Surgical Cure for Diabetes Will Fail! Two seemingly groundbreaking studies, published this week in the New England Journal of Medicine found that type 2 diabetes, or diabesity, could be cured with gastric bypass surgery. The flurry of media attention and medical commentary hail this as a great advance in the fight against diabetes. The cure was finally discovered for what was always thought to be a progressive incurable disease. But is this really a step backwards? Yes, and heres why. No one is asking the most obvious question. How did the surgery cure the diabetes? Did the surgeons simply cut out the diabetes like a cancerous tumor? No. The patients in the studies changed their diet. They changed what they put in their stomach and thats something that doesnt require surgery to change. If they had surgery and they didnt stop binging on donuts and soda they would get violently ill and vomit and have diarrhea. Thats enough to scare anyone skinny. If I designed a study that gave someone an electric shock every time they ate too much or the wrong thing, I could reverse diabetes in a few weeks. But you can get the benefits of a gastric bypass without the pain of surgery, vomiting, and malnutrition. Most dont realize that after gastric bypass diabetes can disappear within a week or two while people are still morbidly obese. How does this happen? It is because food is the most powerful drug on the planet and real whole fresh food and can turn on thousands of healing genes and hundreds of healing hormones and molecules that create health within days or weeks. In fact, what you put on your fork is more powerful than anything you can find in a prescription bottle. The researchers asked the wrong question. It should no Continue reading >>
New Way To Beat Diabetes: Single Operation Could Cure Type 2 Disease, Says Uk Doctors
The procedure – using a plastic liner in the gut – either cleared the condition or made its effect much milder. It could also end the need for painful daily insulin injections. Results from the ground-breaking treatment have been so encouraging experts last night called for surgery to be “fully recognised” as an option for Type 2 diabetes. Under the procedure, patients have the plastic liner fitted into the stomach to stop the walls of the upper gut coming into contact with food. It blocks key hormones entering the blood. Professor Francesco Rubino, who is leading the research at King’s College Hospital in London, said: “In many patients, blood sugar levels go back to normal within days.” The trials offer fresh hope to the four million people living with lifestyle driven Type 2 diabetes. Prof Rubino added: “About 50 per cent of patients are diabetes free after these procedures. The remaining people demonstrate big improvements of blood sugar control and can drastically reduce their dependence on insulin or other medication.” Fri, August 19, 2016 Diabetes is a common life-long health condition. There are 3.5 million people diagnosed with diabetes in the UK and an estimated 500,000 who are living undiagnosed with the condition. The trials are taking place at King’s and University College Hospital and City Hospital in Birmingham, Britain’s “diabetes capital”. The flexible plastic stomach sleeves were developed to mimic the effects of a gastric bypass without surgery and have been approved for clinical use in Europe and South America. In British trials, patients fitted with the 23½inch-long “EndoBarrier” sleeve have seen marked improvement in symptoms. Those fitted with it had lived with Type 2 for 12 years on average and usual treatments, inc Continue reading >>
Is Weight Loss Surgery A Cure For Some Cases Of Type 2 Diabetes?
Across the world, articles about gastric sleeves and other forms of bariatric surgery are raising hopes of a cure for type 2 diabetes. Unlike type 1 diabetes, in which the body's production of insulin is destroyed by an auto-immune response with no known cure, type 2 is a progressive condition. In about 60 percent of type 2 cases, onset can be avoided or progression halted by changes to exercise and food intake. That still leaves about 40 percent of type 2 cases in which other factors (such as family and genetic history) play the greater part. In cases such as the one examined in the attached article (published by the South Burnett Times, Ipswich Advertiser and others this week), some people who achieve weight loss following bariatric surgery report positive outcomes including a reduced need for medication and improved blood glucose (BGL) levels. This potential, particularly as it relates to people with type 2 diabetes and those with pre-diabetes or at risk of type 2 diabetes, has been evaluated in a detailed position paper published by Diabetes Australia. Here's the section discussing options for people living with type 2 diabetes: People with diabetes Losing excess weight will assist in the management of diabetes. Healthy eating and physical activity should be the initial approach to weight loss and is a priority in the ongoing management of diabetes. Bariatric surgery is a treatment option for people with type 2 diabetes with a Body Mass Index (BMI) over 35, where lifestyle interventions and medical treatments for obesity or diabetes have not been successful. Most people with type 2 diabetes experience improved blood glucose levels after bariatric surgery, which for some will return to normal without the need for medication. Medication may be reduced or ceased. Blood Continue reading >>
Why Doctors For Diabetics Now Recommend Surgery Instead Of Drugs
Clinical guidelines published this week announce what may be the most radical change in the treatment of type 2 diabetes for almost a century. Appearing in Diabetes Care, a journal of the American Diabetes Association, and endorsed by 45 professional societies around the world, the guidelines propose that surgery involving the manipulation of the stomach or intestine be considered as a standard treatment option for appropriate candidates. This development follows multiple clinical trials showing that gastrointestinal surgery can improve blood-sugar levels more effectively than any lifestyle or pharmaceutical intervention, and even lead to long-term remission of the disease. As someone who has been investigating the link between gastrointestinal surgery and glucose homeostasis since the late 1990s, I have witnessed first-hand how getting to this point has required many clinical scientists to put aside long-standing preconceptions. Indeed, the guidelines come nearly 100 years after the first clinical observations that diabetes could be improved or even resolved by a surgical operation. The evidence that surgery can prompt the remission of a disease that has long been considered irreversible could bolster searches for what causes diabetes and even reinvigorate hopes to find a cure. But future progress will require more thinking outside the box. Clinical shift The number of adults around the world with diabetes quadrupled from 108 million in 1980 to 422 million in 2014. About 90% of these people have type 2 diabetes—a major cause of kidney failure, blindness, nerve damage, amputations, heart attack and stroke. Fewer than 50% of people with type 2 diabetes control their blood-sugar levels adequately by changing their diet or exercise regime, or by taking drugs. Bariatric o Continue reading >>
- Cholesterol Drugs Cause Rapid Aging, Brain Damage And Diabetes. Use These Natural Solutions Instead
- Could going low-carb help you fight off diabetes? The usual advice for Type 2 is to eat plenty. But now a number of patients and doctors are leading a growing rebellion
- Metabolic surgery for treating type 2 diabetes mellitus: Now supported by the world's leading diabetes organizations
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 >>
Weight Loss Surgery For Type 2 Diabetes
For many years, a variety of obesity surgery procedures applied to the stomach or intestine have been used as a method of losing weight, and losing weight can help people manage their Type 2 diabetes. More recently, medical research has shown that obesity surgery can also directly affect how the body uses insulin. In addition to the benefit of directly losing weight and improving blood sugar levels, this surgery itself assists people in managing their Type 2 diabetes. It can: change how the hormones in your gut work, which in turn affects how your body makes insulin increase the amount of bile acids that your body makes – these make your body cells more sensitive to insulin improve the way the cells use insulin, leading to lower blood sugar levels. What are the different versions of Type 2 diabetes surgery? There are various forms of obesity surgery, also known as bariatric surgery, that may be offered. Surgical options include removal of part of the stomach to reduce stomach size and consequently restrict appetite and food intake, or a surgical re-route of the digestive system to bypass the stomach. Both treatments assist people in reducing their food intake due to requiring less food to feel full, but also beneficially affect how your body uses insulin. You can discuss surgery with your diabetes healthcare team, who will be able to give you further information. Who can have surgery for diabetes? Until now, surgery of this type hasn’t been fully recognised as a standard treatment for Type 2 diabetes. NICE obesity guidelines recommend surgery for weight loss for people who meet certain strict criteria, including those newly diagnosed with Type 2 diabetes. However, in practice surgery is mostly offered only for a restricted group of people who have already attempted Continue reading >>
Surgical Treatment Of Type 2 Diabetes
1Department of Internal Medicine, University Hospital Leipzig *Department fr Innere Medizin Universitt Leipzig Liebigstr. 20 [email protected] See " Renal Function in Type 2 Diabetes Following Gastric Bypass " in volume 113 onpage827. With a prevalence of 58%, type 2 diabetes is one of the most common metabolic disorders in Germany. Chronic hyperglycemia goes hand in hand with an increased risk for microvascular complications, such as diabetic retinopathy, neuropathy, and nephropathy. This makes type 2 diabetes one of the most common causes of loss of eyesight, renal failure, and amputation of the lower limb ( 1 ). Diabetic nephropathy is the most common complication of type 2 diabetes and results in a substantially impaired quality of life for those affected. It also incurs high costs to the healthcare systemowing to expensive dialysis therapy, among others ( 2 ). In addition to age, familial predisposition, and certain lifestyle factors, overweight is one of the factors promoting the manifestation of type 2 diabetes. Weight loss can help to delay the manifestation of type 2 diabetes, and weight reducing measures constitute basic treatment (lifestyle management/intervention) in patients with type 2 diabetes. Individually agreed therapeutic goals (normalizing blood glucose concentrations, weight reduction) are, however, rarely achieved by means of basic therapy alone; the guideline conform standard in this setting is stepwise escalation of pharmacotherapy for type 2 diabetes ( 1 ). Metabolic surgery and diabetic nephropathy Since weight reduction for patients with type 2 diabetes and obesity is hard to achieve by means of conservative strategies, in recent years, metabolic surgeryespecially Roux-en-Y gastric bypass surgeryhas become an established therapeuti Continue reading >>
- Surgical cure for type 2 diabetes by foregut or hindgut operations: a myth or reality? A systematic review
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- Is It Time to Change the Type 2 Diabetes Treatment Paradigm? No! Metformin Should Remain the Foundation Therapy for Type 2 Diabetes
Experts Urge Surgery To Cure Type-2 Diabetes
Experts Urge Surgery To Cure Type-2 Diabetes World experts claim weight-loss surgery is a cost-effective option and should be recognised as a standard treatment. By Thomas Moore, Health and Science Correspondent Up to 100,000 people in the UK should be offered weight-loss surgery in the hope of curing their diabetes, world experts have said. A leading group of international diabetes organisations, including Diabetes UK, says the evidence is now so strong that obesity surgery can also reverse type-2 diabetes that it should be considered a standard treatment option. But prejudice in the medical profession, and pressure on NHS resources, means just 6,000 patients a year are having the procedure. So far 11 scientific trials have shown that surgery to reduce the size of a patients stomach can reduce blood sugar levels below the threshold used to diagnose type-2 diabetes. And one study showed almost all patients were able to stop taking insulin or other injectable medication to control their blood sugar. The condition affects around 3.5 million people in the UK and is closely related to obesity. The new guidelines, published in the journal Diabetes Care, say surgery should be considered in people with type-2 diabetes who have a body mass index (BMI) of 40 or over, and those with a BMI of at least 30 and blood sugar levels that aren't properly controlled by medication or lifestyle changes. The guidelines are consistent with those already issued by the NHS watchdog NICE. But clinical commissioning groups, which fund treatments, widely ignore the recommendations. The operation costs at least 6,000, but because of future healthcare savings the money is generally recouped within two years. Weight-loss, or bariatric surgery, can include reducing the size of the stomach with a gast 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 >>
A New Look At How Gastric Bypass "cures" Type 2
A New Look at How Gastric Bypass "Cures" Type 2 David Bernlohr (left) and his research partner, surgeon Sayeed Ikramuddin. Biochemist, University of MinnesotaTwin Cities College of Biological Sciences and Medical School For years, scientists have marveled at the effects of gastric bypass surgery. The operation, which involves surgically removing part of the stomach and small intestine, physically restricts the amount of food people are able to consume and digest, leading to dramatic weight loss. Even more remarkable, the procedure puts type 2 diabetes in remission for some people. The surgery restores the body's sensitivity to insulin and revives the pancreatic cells that produce it, even before any weight loss occurs. Biologists studying the phenomenon say it has something to do with inflammation, caused by overactive immune cells that build up in fatty tissue. "One of the key observations in human biology is that when an individual transitions from lean to obese, there's an increase in inflammation," says David Bernlohr, PhD, a researcher at the University of MinnesotaTwin Cities. That inflammation leads to things such as insulin resistance, which means the body needs to produce more and more insulin to control blood glucose levels. Eventually, the insulin-producing cells in the pancreas begin to give out, causing type 2 diabetes. After gastric bypass surgery, though, inflammation seems to decrease or disappear almost immediately. Tiny engines inside the cells called mitochondria that shut down as a result of inflammation grind to life again, increasing the body's sensitivity to insulin in the process. The surgery seems to reverse the course of type 2 diabetes in "just a couple of days," Bernlohr says. Help support diabetes science: Join the Summit Circle, ADA's soci Continue reading >>
Metabolic And Bariatric Surgery And Type 2 Diabetes
Did You Know? Someone in the world dies from complications associated with diabetes every 10 seconds. Diabetes is one of the top ten leading causes of U.S. deaths. One out of ten health care dollars is attributed to diabetes. Diabetics have health expenditures that are 2.3 times higher than non-diabetics. Approximately 90 percent of type 2 diabetes mellitus (T2DM), the most common form of diabetes, is attributable to excessive body fat. If current trends continue, T2DM or pre diabetic conditions will strike as many as half of adult Americans by the end of the decade. (according to the United HealthGroup Inc., the largest U.S. health insurer by sales). The prevalence of diabetes is 8.9 percent for the U.S. population but more than 25 percent among individuals with morbid obesity. Metabolic and bariatric surgery is the most effective treatment for T2DM among individuals who are affected by obesity and may result in remission or improvement in nearly all cases. Type 2 Diabetes Mellitus (T2DM) Type 2 diabetes(T2DM) is the most common form of diabetes, accounting for approximately 95 percent of all cases. Obesity is the primary cause for T2DM and the alarming rise in diabetes prevalence throughout the world has been in direct association increase rates of obesity worldwide. T2DM leads to many health problems including cardiovascular disease, stroke, blindness, kidney failure, neuropathy, amputations, impotency, depression, cognitive decline and mortality risk from certain forms of cancer. Premature death from T2DM is increased by as much as 80 percent and life expectancy is reduced by 12 to 14 years. Current therapy for type 2 diabetes includes lifestyle intervention (weight-loss, appropriate diet, exercise) and anti-diabetes medication(s). Medical supervision and strict adh Continue reading >>
Surgery For Weight Loss: A Standard Treatment For Type 2 Diabetes?
Gastric bypass procedure should be used more often, experts say Weight-loss surgery not only leads to dramatic weight loss, it also reverses type 2 diabetes in most people who undergo these stomach-shrinking procedures. In fact, international diabetes organizations now say that surgery for weight loss should become a more routine treatment option for people with type 2 diabetes—even those who are only mildly obese. Many of the estimated 29 million Americans with type 2 diabetes are overweight or obese. Marked by high levels of sugar in the blood, type 2 diabetes boosts the risk of heart disease, kidney disease, eye and nerve complications, and other serious health problems. Currently, weight-loss surgery is considered appropriate for two groups of people: those with extreme obesity (a body mass index, or BMI, of 40 or higher; see www.health.harvard.edu/bmi for a calculator) or those only with moderate obesity (BMI of 35 or higher) who also have an obesity-related health problem, such as type 2 diabetes, high blood pressure, or sleep apnea. But even people with mild obesity (a BMI between 30 and 35) who have trouble controlling their blood sugar levels should be considered candidates for weight-loss surgery (also known as bariatric surgery). That's according to a joint statement endorsed by 45 international diabetes organizations, published in the June 2016 issue of Diabetes Care. Weight-loss surgeries: What are they? The two most common weight-loss procedures are the gastric bypass procedure and the gastric sleeve. Most are done through several small belly incisions. Gastric bypass. This surgery creates an egg-sized pouch that bypasses most of the stomach and is then attached to the small intestine. First done in the 1960s, it's considered the gold-standard surgery an 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 >>