Could weight loss surgery help end diabetes

A "sensational" new finding could be the beginning of a cure for type 2 diabetes, a disease described in an editorial accompanying the research in the New England Journal of Medicine as “one of the fastest growing epidemics in human history.” Two studies find that weight loss surgery can eliminate the symptoms of type 2 diabetes in a large proportion of volunteers. That might not seem surprising, since obesity is the major risk factor for the disease. But in these studies, published in the New England Journal of Medicine and presented Monday at the annual meeting of the American College of Cardiology, many of the patients got better within weeks, days, sometimes even hours after the surgery -- long before they lost any weight.It’s pretty amazing,” said Dr. Phil Schauer of the Cleveland Clinic, the lead author on one of the studies. Schauaer’s study divided 150 patients with out-of-control diabetes into three groups. One-third got the best drug therapy, the next gastric-banding surgery, and last gastric bypass. The goal was to get the patients’ blood sugar (measured by the A1C test familiar to diabetics) below the normal level of 6 percent. Forty-two percent of the bypass patients reached the goal after one year compared to 37 percent of the banding patients and only 12 percent on medical therapy. But those numbers “don’t even begin to show how successful this was," according to Dr. Steve Nissen, another author of the paper from the Cleveland Clinic. He points out that at the beginning of the study most of the patients were taking three or more medications to control their diabetes. But after a year almost none of the gastric-bypass patients needed medication.  Forty-four percent required daily insulin injections before surgery and none did after.  Diabetes is a major risk factor for heart disease.  Most of the surgery patients saw their HDL, the good cholesterol, shoot way up and their artery clogging triglycerides drop sharply. “This is sensational,” Nissen told me. The second study from the Catholic University of Rome and Weill Cornell Medical College followed sixty patients for two years and produced even stronger results.  In that experiment one third of the volunteers got drug therapy, one third bypass surgery, and the last group underwent bilopancreatic diversion, an even more severe weight-loss operation where surgeons block part of the small intestine. After two years none of the patients on drug therapy reached the goal of normal blood sugar levels while 75 percent of those who underwent bypass did and as did fully 95 percent of those undergoing the bilopancreatic diversion.  The authors of the study say these patients have achieved “complete diabetes remission.” Though the doctors have followed them for only two years, there is no indication that the diabetes is returning in any of them. Why, in some patients, do the positive effects take place long before they lose weight? Marla Evans, 56, one of the volunteers who got gastric banding in the Cleveland study put it this way, “I was a diabetic, and then after the surgery, within a few days, the diabetes was much better, and within a month or two there was no diabetes in my blood at all.”Most experts believe the operations somehow set off massive changes in the body’s hormones. Exactly what and how remains a mystery. “This is hotly debated area,” Dr. Rudy Leibel of Columbia University, an authority on metabolic hormones told me.  And it is critical because if scientists can figure out how to bring about the changes that control the diabetes without surgery or with far less invasive surgery, the treatment could easily be more widespread. But even now medicine faces the question:  Is it worth undergoing surgery that costs about $25,000 and carries a significant risk of dangerous complications and unpleasant side effects to treat type 2 diabetes? The answer, most experts say, is that most type 2 diabetics (type 1 diabetes is an auto-immune disease not impacted by this research) can stay well with diet, exercise and medication. But those who cannot control their disease face complications including heart and kidney disease, along with loss of limbs and visions. One person with uncontrolled diabetes can run up millions in medical bills.  So a surgery that was considered extreme not long ago may become a standard treatment for many people with one of the most common diseases of modern times.