There's more evidence that obese patients with type 2 diabetes can control the disease better with weight-loss surgery, compared to medication alone.
New research shows that five years after weight-loss surgery, known as bariatric surgery, those who had the procedure showed better improvements in quality of life and overall health, and some no longer needed insulin, compared with those who only took diabetes medications.
"About a third of the patients who had surgery were able to achieve a complete remission of their diabetes -- their blood sugar returned to normal and they did not need medications," said lead researcher Dr. Philip Schauer. He is director of the Cleveland Clinic Bariatric and Metabolic Institute in Ohio.
"Surgery has come as close as any treatment that we know of that can lead to long-term remission of type 2 diabetes, which is about as close to a cure as you can get," Schauer added.
Diabetes affects 29 million people in the United States, according to the U.S. Centers for Disease Control and Prevention. More than 70,000 people die each year from complications associated with the blood sugar disease, the American Diabetes Association reports.
According to Dr. Samer Mattar, a spokesman for the American Society for Metabolic and Bariatric Surgery, "Bariatric surgery is the most effective and durable treatment we have for obese patients with type 2 diabetes. It goes way beyond weight loss and improves the health of many patients with chronic disease." Mattar is also a professor of surgery at Oregon Health and Science University in Portland.
For the study, Schauer and colleagues followed 150 obese patients with type 2 diabetes who were randomly assigned to medication alone or to medication plus weight-loss surgery -- either Roux-en-Y gastric bypass or sleeve gastrectomy.
In Roux-en-Y gastric bypass, the surgeon reduces the size of the stomach by creating a small pouch about the size of an egg that becomes the new stomach.
In sleeve gastrectomy, the size of the stomach is reduced by removing most of it and creating a new stomach about the size of a banana.
Five years later, the researchers looked for reductions in blood sugar and whether patients could stop taking their diabetes medications.
Among the patients who completed the study, two of the 28 patients assigned to medical treatment alone were able to stop their diabetes medications (5 percent). This compared with 14 of the 49 patients who had gastric bypass surgery (29 percent), and 11 of the 47 patients who underwent sleeve gastrectomy (23 percent), Schauer's team found.
In addition, patients who had weight-loss surgery also had lower blood sugar than patients treated with medication alone.
People who underwent surgery lost significantly more weight and had dramatically lower triglycerides and cholesterol (blood fats) than those who were treated with medication alone, the researchers found.
No major late surgical complications were reported, except for one reoperation, the study authors said.
According to Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, "This study shows that bariatric surgery is an option for management of patients with type 2 diabetes."
However, he added that treatment always needs to be "patient-centric, so that the different options are negotiated and the best option is available for each patient."
Another specialist, Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City, said that obese patients should consider surgery to help them get their diabetes under control.
"All obese type 2 diabetics should look at these results and give greater consideration to surgery," Roslin said. "These data show that surgery should not be the last resort -- it is the best treatment we have for type 2 diabetes."
Schauer noted that weight-loss surgery is a minimally invasive procedure, so the risks are dramatically reduced. The operation costs $20,000 to $25,000 and is usually covered by insurance, he said.
The report was published Feb. 16 in the New England Journal of Medicine.
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