Two stud­ies say surgery can halt Type 2 di­a­betes

Weight-loss pro­ce­dure not last re­sort

The Washington Times Daily - - Nation - BY MAR­I­LYNN MAR­CHIONE

CHICAGO | New re­search gives clear proof that weight-loss surgery can re­verse and pos­si­bly cure di­a­betes, and doc­tors say the op­er­a­tion should be of­fered sooner to more peo­ple with the dis­ease — not just as a last re­sort.

The two stud­ies, re­leased Mon­day, are the first to com­pare stom­ach-re­duc­ing op­er­a­tions with medicines alone for “di­a­besity” — Type 2 di­a­betes brought on by obe­sity. Mil­lions of Amer­i­cans have this and can’t make enough in­sulin or use what they do make to process sugar from food.

Both stud­ies found that surgery helped far more pa­tients achieve nor­mal blood-sugar lev­els than medicines alone did.

The re­sults were dra­matic: Some peo­ple were able to stop tak­ing in­sulin as soon as three days af­ter their op­er­a­tions. Choles­terol and other heart risk fac­tors also greatly im­proved.

Doc­tors don’t like to say “cure” be­cause they can’t prom­ise a dis­ease will never come back. But in one study, most surgery pa­tients were able to stop all di­a­betes drugs and have their dis­ease stay in re­mis­sion for at least two years. None of those treated with medicines alone could do that.

“It is a ma­jor ad­vance,” said Dr. John Buse of the Univer­sity of North Carolina at Chapel Hill, a lead­ing di­a­betes ex­pert who had no role in the stud­ies. Dr. Buse said he of­ten rec­om­mends surgery to pa­tients who are obese and can’t con­trol their blood-sugar through med­i­ca­tions, but many are leery of it. “This ev­i­dence will help con­vince them that this re­ally is an im­por­tant ther­apy to at least con­sider,” he said.

There were signs that the surgery it­self — not just weight loss — helps re­verse di­a­betes. Food makes the gut pro­duce hor­mones to spur in­sulin, so trim­ming away part of it sur­gi­cally may af­fect those hor­mones, doc­tors think.

Weight-loss surgery “has proven to be a very ap­pro­pri­ate and ex­cel­lent treat­ment for di­a­betes,” said one study co-leader, Dr. Francesco Ru­bino, chief of di­a­betes surgery at New York-pres­by­te­rian Hospi­tal/weill Cor­nell Med­i­cal Cen­ter. “The most proper name for the surgery would be di­a­betes surgery.”

The stud­ies were pub­lished on­line by the New Eng­land Jour­nal of Medicine, and the larger one was pre­sented Mon­day at an Amer­i­can Col­lege of Car­di­ol­ogy con­fer­ence in Chicago.

Tamikka Mccray, 39, who lives in New York and works for the city’s Hu­man Re­sources Ad­min­is­tra­tion, also had suc­cess from her surgery a year and a half ago. When she left the hospi­tal, her di­a­betes had dis­ap­peared be­fore any ma­jor weight loss had a chance to oc­cur.

“That was the crazy part,” she said. “I didn’t un­der­stand that when they came in and they checked it. My sug­ars were nor­mal.” She added: “I left the hospi­tal with no med­i­ca­tion. And I haven’t been on any­thing since.”

More than a third of Amer­i­can adults are obese, and more than 8 per­cent have di­a­betes, a ma­jor cause of heart dis­ease, strokes and kid­ney fail­ure. Be­tween 5 mil­lion and 10 mil­lion are like the peo­ple in these stud­ies, with both prob­lems.

For a cen­tury, doc­tors have been treat­ing di­a­betes with pills and in­sulin, plus en­cour­ag­ing weight loss and ex­er­cise with limited suc­cess. Few very obese peo­ple can drop enough pounds with­out surgery, and many of the medicines used to treat di­a­betes can cause weight gain, mak­ing things worse.


Dr. Francesco Ru­bino, a sur­geon at New YorkPres­by­te­rian Hospi­tal/weill Cor­nell Med­i­cal Cen­ter, joins Tamikka Mccray for an in­ter­view Fri­day. She no longer needs to take di­a­betes med­i­ca­tion and in­sulin since her weight-loss surgery.

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