May 4, 2008 in Nation/World

Bypass surgery called ‘solution to diabetes’

Washington Post The Spokesman-Review
 

Proponents say a novel procedure – an operation bypassing part of the patient’s small intestine – appears to offer the most important advance since the discovery of insulin in treating diabetes.

“It’s extremely promising,” said Madhu Rangraj, chief of laparoscopic surgery at the Sound Shore Medical Center in New Rochelle, N.Y. “It’s a surgical solution to diabetes.”

While many surgeons share Rangraj’s enthusiasm, and some diabetes experts agree that the operation and similar ones may lead to fundamental new insights into the disease, other experts remain cautious. Much more research is needed, they say, to validate the effectiveness of the procedures. They worry that the operations will start to proliferate before their long-term safety and effectiveness have been proven, as often occurs with novel surgeries.

“I’m skeptical,” said R. Paul Robertson, president-elect of the American Diabetes Association. “It bothers me to see this message being put out there that we can now cure diabetes through surgery.”

The operation is a variation of a procedure developed to treat severe obesity. Known as bariatric surgery or gastric bypass, the standard operations reduce the size of the stomach and bypass part of the intestine. That limits the amount of food a person can eat and the calories that can be absorbed. The procedures have soared in popularity as the obesity epidemic has spread and clinical trials have validated their safety and effectiveness.

Although doctors have long known that losing weight can alleviate Type 2 diabetes, the most common form of the disease, they were surprised to discover that many patients saw their blood sugar return to normal remarkably quickly after the operations, often within days – and before they had lost much weight.

“There’s something significant that’s happening as a result of this surgery that we haven’t yet identified,” said Neil Hutcher, a Richmond, Va., surgeon and senior past president of the American Society for Metabolic and Bariatric Surgery. “I think it’s the most significant advance in the management of this chronic killing disease since the discovery of insulin.”

In dozens of studies involving thousands of patients, standard gastric bypass surgery cleared up diabetes in more than 80 percent of obese patients who had the disease, raising the possibility that surgery would help those who weigh less. Currently, the procedure is recommended only for those who are severely or moderately obese and have diabetes or other serious complications. But surgeons have started testing the operation on patients who are less obese, just overweight or even at normal weight.


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