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)

 

Surgery is best for managing diabetes in heavy people

WASHINGTON: When it comes to managing type 2 diabetes in overweight people, stomach-shrinking surgeries are still more effective than trying to shed pounds with pills and lifestyle changes, researchers said Monday.

Three years into a US study that compares various approaches -- gastric bypass, sleeve gastrectomy and simply trying medical counseling, diet, exercise and weight loss medications -- the findings show that the two surgical procedures are still superior at reducing blood sugar and weight.

Researchers said their findings could provide a way to help the some 23 million American adults who have type 2 diabetes, most of whom are overweight or obese.

Fewer than half of adults with diabetes are able to get their blood sugar under control with medication, experts say.

The latest results from the largest randomized controlled trial of its kind were published in the New England Journal of Medicine and discussed at the American College of Cardiology annual meeting.

"Bariatric surgery was more effective than medical therapy in achieving glycemic control with weight loss as the primary determinant of this outcome," said study author Sangeeta Kashyap, associate professor medicine at Cleveland Clinic Lerner College of Medicine.

"We concluded that bariatric surgery should be considered as a treatment option for the treatment of type 2 diabetes in patients who are moderately and severely overweight."

- More weight lost by surgery -

The research included 150 overweight people with uncontrolled diabetes that had persisted for at least eight years when they began the study, despite taking three or more medications.

They were randomly assigned to undergo one of the two surgeries plus counseling, or simply expert therapy in health changes without surgery.

After three years, just five percent of patients who did not have surgery had achieved the desired level of glycemic control, defined as a three-month average blood glucose level of six percent or lower.

That target is slightly more aggressive than the American Diabetes Association recommendation of seven percent.

The surgery groups did much better, with 37.5 percent of gastric bypass and 24.5 percent of sleeve gastrectomy patients meeting the mark, after starting at an average blood sugar level of 9.2 percent.

Weight loss was five to six times greater in patients who had one of the surgeries.

The gastric bypass group lost on average a quarter of their body weight while the sleeve gastrectomy patients shed 21 percent. Those on medical therapy alone lost four percent.

- Quality of life -

Meanwhile, people who did not undergo surgery reported no improvements in quality of life, according to eight measures including body pain, general health, energy and fatigue.

Gastric bypass patients reported five improvements and sleeve patients reported two. There were no major complications among those who underwent the surgeries.

Gastric bypass involves reducing the stomach to below three percent of its natural volume, then connecting a new gastric pouch that bypasses the stomach and goes straight to the intestine.

In sleeve gastrectomy, part of the patient's stomach is removed to reduce its volume by about 75 percent.

Gastric bypass outperformed the sleeve gastrectomy in the study, which was funded by the National Institutes of Health, the Cleveland Clinic and Ethicon, a division of pharmaceutical giant Johnson and Johnson which sells surgical products for weight loss.

Amit Khera, associate professor at the University of Texas Southwest Medical Center, who was not involved in the study, described the research as "important" because it addresses the longer-term benefits from surgery versus counseling and weight loss attempts alone.

"In the surgical arm, it does seem to be quite durable," he told reporters.

"Normalizing blood sugar seems to be retained at three years. That is a really important observation."

On the other hand, people who did not have surgery showed early improvements in their blood sugar, dropping close to the target of 7.5 in the first year.

But that group was back up to 8.4 percent in year three.

The study, called the Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial, is designed to follow its patients for a total of five years.