Bariatric surgery yields higher diabetic remission: study

WASHINGTON: Stomach-shrinking bariatric surgery beats other forms of treatment in bringing about remission of type 2 diabetes in the obese, according to a Swedish study out Tuesday.

The study, to appear in Wednesday´s issue of the Journal of the American Medical Association (JAMA), also found that the procedure was linked to fewer diabetes-related complications in the severely overweight. The findings come at a time when obesity and diabetes have reached epidemic proportions, creating a costly public health problem.

In the United States, more than 29 million people -- or 9.3 percent of the population -- had diabetes in 2012, up from an estimated 26 million two years earlier, the Centers for Disease Control and Prevention said Tuesday.

Treating the disease and related complications amounted to $245 billion in medical expenses, as well as lost pay in 2012, up from $174 billion five years earlier.

Carried out by a team led by Lars Sjostrom of the University of Gothenburg, the findings to appear in JAMA involved a follow-up of the Swedish Obese Subjects study.

The median follow-up time was 18.1 years for people who had had surgery and 17.6 years in the control group in an effort to determine the long-term effects of bariatric procedures, diabetes remission and diabetes-linked complications.

The authors found that the proportion of people with type 2 diabetes who had bariatric surgery and were in remission was 72.3 percent two years after the procedure, compared to 16.4 percent in the control group.

Fifteen years on, the diabetes remission rates were 30.4 percent for those who had surgery, significantly higher than the 6.5 percent remission in the control group. All kinds of bariatric surgery -- including gastric bypass and adjustable and nonadjustable banding procedures -- "were associated with higher remission rates compared with usual care," said a release announcing the study.

What´s more, according to the authors who say the findings require confirmation through randomized trials, this type of surgery is also linked to a lower incidence of micro- and macrovascular complications.

According to Tuesday´s CDC data, one in four people with diabetes in the United States aren´t aware they have the disease.

What´s more, 86 million US adults aged 20 and older have what is known as prediabetes -- that´s when blood sugar levels are above normal but not high enough to be deemed type 2 diabetes.

Without shedding pounds and engaging in moderate physical activity, 15 to 30 percent of this at risk group could develop the full-blown disease within five years, the CDC warned.

It said 208,000 people younger than 20 have been diagnosed with type 1 and type 2 diabetes. "These new numbers are alarming and underscore the need for an increased focus on reducing the burden of diabetes in our country," said CDC official Ann Albright.

"Diabetes is costly in both human and economic terms. It´s urgent that we take swift action to effectively treat and prevent this serious disease." (AFP)

 

Diabetic heart attacks, strokes falling: study

5  1

NEW YORK: In the midst of the diabetes epidemic, a glimmer of good news: Heart attacks, strokes and other complications from the disease are plummeting.

Over the last two decades, the rates of heart attacks and strokes among diabetics fell by more than 60 percent, a new federal study shows. The research also confirms earlier reports of drastic declines in diabetes-related kidney failure and amputations.

The drop is mainly attributed to better screening, medicines and care. The improvements came even as the number of U.S. adults with diabetes more than tripled in those 20 years.

"It is great news," said Dr. John Buse, a University of North Carolina diabetes specialist, of the drop in rates.

"The prognosis for folks with diabetes has improved dramatically over the last two decades, at least for those with good access to care," Buse said in an email. He was not involved in the study.

The Centers for Disease Control and Prevention research is reported in Thursday's New England Journal of Medicine.

Diabetes is a disease in which sugar builds up in the blood. The most common form is tied to obesity, and the number of diabetics has ballooned with the rise in obesity. Today, roughly 1 in 10 U.S. adults has the disease, and it is the nation's seventh leading cause of death, according to the CDC.

The obese are already at higher risk for heart attacks and strokes. But diabetics seem to have more narrowing of their blood vessels - a condition that can further foster those problems.

In the 1990s, key studies showed that diabetics could keep their blood sugar, blood pressure and cholesterol under control. The research suggested that vision and heart problems, leg and foot amputations and other diabetes complications were not necessarily inevitable.

Meanwhile, insurance programs expanded coverage of blood sugar monitors and diabetes treatment. Gradually, larger numbers of diabetics were diagnosed earlier and with milder disease.

For the new study, the CDC tallied complication rates from 1990 to 2010 for diabetics ages 20 or older.

During that time, the heart attack rate fell 68 percent, from 141 to 45.5 per 10,000 diabetics, according to hospital records.

The decline was so great that, despite the growing ranks of diabetics, the actual number hospitalized with heart attacks dropped from more than 140,000 to about 136,000.

The stroke rate fell less dramatically - but still declined by more than half, finishing at 53 per 10,000. The heart attack and stroke rates for diabetics are essentially even now, lead author Edward Gregg noted.

The researchers saw declines in hearts attack and stroke rates for non-diabetics as well, but those improvements weren't nearly as big as they were for diabetics.

Amputation rates also fell by more than half. However, like strokes, the actual number increased over the two decades.

The growth in the number of diabetics "wiped out most of the gains" from the declining rates, so the number who ended up in the hospital for strokes or amputations swelled, said Dr. Robert Gabbay, of Boston's Joslin Diabetes Center.

The study also found that the rate of kidney failure dropped by 28 percent. But that wasn't true for all ages - the rate in those 65 and older actually increased, for reasons that aren't clear. That could be a sign diabetics are living longer - long enough to get kidney disease, Gregg speculated.

The researchers also looked at a less common complication, death caused by dangerous levels of blood sugar. The rate of such deaths dropped by 64 percent; the numbers also declined by 18 percent. In 2010, those deaths totaled 2,361.