Heart Disease Prevention - Can Weight-Loss Surgery Reverse Diabetes?

People who are overweight and obese have a much higher chance of getting Type-2 diabetes, compared to those with a healthy weight. A paper published online March 31, 2014 in the ‘New England Journal of Medicine’ argued that performing weight-loss surgery on obese patients with Type-2 diabetes could effectively reverse the disease, allowing most of them to stop using insulin and many to stop diabetes medication 3 years later.

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Heart Disease Prevention - Can Weight-Loss Surgery Reverse Diabetes?

Would Weight-Loss Surgery Benefit Diabetics?

When a person becomes obese, the only option he or she can opt for is to lose weight. This is because obesity could lead to many serious medical conditions including Type-2 diabetes, heart disease, high blood pressure and stroke.

Of course, there are several avenues that can help achieve the weight loss.  First of all, he or she should start off with combining a reduction of processed foods high in saturated fats, sugar, salt and caloric content of the diet with an increase in physical activity.

If this fails, which always does, he or she might have to approach the doctors for other means that include use of drugs to decrease appetite, block fat absorption or reduce stomach volume.

Bariatric surgery might be recommended in cases of severe obesity. 2 effective types of bariatric surgical procedures are gastric bypass and gastric banding that can limit intake of food energy by reducing stomach size. 

The FDA (Food and Drug Administration) has approved gastric banding for people with a BMI (Body Mass Index) between 30 and 35 who have an illness linked to obesity. Each year, more than 113,000 bariatric surgeries are performed in the United States. They have saved countless lives but these procedures do carry risks as with any other surgery. As they are complex surgeries, they sometimes result in serious complications. The complication rate for all types of bariatric surgery is about 7.5 percent, according to the National Institutes of Health.

However, a gastric bypass or other type of weight-loss surgery could actually help diabetics who are moderately obese. This was what researchers from the University of California, Los Angeles, Rand Health, VA Greater Los Angeles Healthcare System, Olive View-University of California, and the Akasha Center for Integrative Medicine wrote in their paper that was published on June 5, 2013 in ‘Journal of the American Medical Association’ (JAMA).

Their analysis was based on a review of evidence supporting the use of bariatric surgery to treat people who are diabetic and who have a BMI of between 30 and 35, considered to be on the low end of the obesity spectrum.

Diabetics with moderate obesity were found to lose more weight and had better glucose control over 2 years if they got such surgery rather than opting for non-surgical treatment like dieting and drugs. The researchers also noted that patients who had a gastric bypass achieved better results (more short term weight loss and better control of blood sugar levels) than those who underwent gastric banding.

But since the findings were arrived from a relatively small number of trials, it is necessary to carry out more studies to include on how patients do after 2 or more years, complication rates and side effects. Until then, it is inappropriate to recommend bariatric surgery over nonsurgical weight-loss treatment to people who are obese.

Would Gastric Bypass Help Achieve Diabetes Remission?

Gastric bypass surgery is a procedure, which involves sectioning off a small portion of the stomach, to create a pouch to limit the amount of food for a person to take. Meanwhile, the surgeon will add a bypass to reroute food past the rest of the stomach and part of the small intestine so that calorie and nutrient absorption could be limited.

Previous studies had shown that such procedure could actually control Type-2 diabetes that is commonly associated with obesity. In the past, it has been thought that the surgery creates hormonal changes that help improvement in diabetes control.

However, the surgeons at Duke University Medical Center in Durham, North Carolina, showed in their latest study that while gastric bypass could cause important metabolic effects that rapidly improve Type-2 diabetes, the key is still the amount of weight patients lose in the first 6 months after surgery. The findings of the study were presented in the month of June 2008 at the annual meeting of American Society for Metabolic and Bariatric Surgery in Washington, DC.

The team studied 71 morbidly obese patients with severe diabetes, which were prescribed with high doses of insulin and oral medications for controlling their blood sugar levels. The purpose of the study was to find out factors that differentiate patients who go into remission from those who do not. “The amount of weight loss by the patient” was identified as the most important factor.

All patients were found to have a better diabetes control as evidenced by better long-term blood sugar levels and lesser medication. Yet, only 48 percent of the patients went into complete remission. According to the researchers, the hormonal effects of gastric bypass surgery are still important but the weight loss in the first 3 weeks to 6 months appears to be a critical factor in diabetes remission.

Morbidly obese patients usually lose about 10 percent of their body weight within 3 weeks of surgery and they can take less medication within the first day or two. This could be an effect on gut hormones, with dramatic improvements in insulin resistance, as explained by the researchers. Nevertheless, greater amount lost at a faster pace seems to improve the chance that patients will remain in remission.

In conclusion, the researchers believed that if the weight-loss effect of surgery could be enhanced by adding medications or rigorous behavior change, it is possible to do better than a 50 percent remission rate.