January 23, 2008 in Nation/World

Study finds stomach surgery effective for Type 2

Thomas H. Maugh Ii Los Angeles Times
 

Stomach banding surgery for weight loss cured nearly three-quarters of obese patients with Type 2 diabetes, five times as many as could be cured by medications, dieting and lifestyle changes, Australian researchers reported today.

In the first head-to-head comparison of banding and conventional weight-loss techniques, obesity specialist John B. Dixon of Monash University in Melbourne and his colleagues found that patients receiving the band lost an average of 20.7 percent of their body weight, while those on a medically supervised diet lost 1.3 percent.

Among those who lost at least 10 percent of their body weight – a number that included only one patient on the medically supervised diet – 87 percent were able to stop taking all diabetes medications within a year.

Among those on the diet who did not lose that much, only 12 percent were able to stop taking medications, and all of them had very mild cases of diabetes to begin with.

The results were “clear and striking,” Dr. David E. Cummings and Dr. David R. Flum, of the University of Washington, wrote in an editorial in the same journal. “It may be time to view bariatric operations … as interventions about which all obese patients with diabetes should be informed and given access.”

Other studies have shown that the more invasive form of bariatric surgery, called a gastric bypass, produces an even bigger weight loss and cures Type 2 diabetes in 80 percent to 85 percent of patients, often within days of the surgery.

The findings demonstrate that “Type 2 diabetes is a disease that should aggressively be treated with surgery and not merely controlled with medication,” said Dr. Mitchell Roslin of Lenox Hill Hospital in New York, who was not involved in the study. “The truth is that the treatment of diabetes requires a lifestyle modification and only surgery makes that practical for the majority of obese diabetics.”

Nearly 20 million Americans have Type 2 diabetes, which is typically associated with obesity. Diabetes is the fifth leading cause of death in the U.S.; the number of deaths from it has grown by 45 percent since 1987, even while the number of deaths from heart disease, cancer and stroke has been declining.

Bariatric surgery also has been growing, with the number of procedures performed yearly reaching 200,000 in 2006, 15 times as many as were performed eight years earlier.

The two major forms of surgery are banding and gastric bypass. In banding, an inflatable silicon band is placed around the stomach to limit its capacity. In a bypass, the stomach’s size is reduced by creating a small pouch at the top to which the intestines are reattached.

The new study is limited by its small size – 60 patients were randomly assigned to receive either surgery or medically supervised weight loss. The patients also had been diagnosed with diabetes within two years of the surgery and did not suffer complications of diabetes, such as peripheral neuropathy.


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