Stomach surgery can treat obesity in diabetics

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Stomach surgery can treat obesity in diabetics

By Charnicia E. Huggins

NEW YORK, Jan 25 (Reuters Health) - Severely obese individuals with type

2 diabetes who undergo a relatively new type of weight-loss surgery may

not only lose weight, but may also improve their diabetes or possibly

send it into remission, according to new study findings.

The surgery, called laparoscopic adjustable gastric banding (LAGB),

involves placing an adjustable band around the upper stomach using

laparoscopy--minimally invasive surgery performed through a small

incision. After the band is in place it is inflated with saline and can

then be adjusted for a tighter or looser fit. Unlike typical gastric

bypass and other more invasive obesity surgeries, LAGB procedures are

reversible.

The makers of the Lap-Band Adjustable Gastric Banding System,

Bioenterics Corporation of California, provided partial funding for the

study.

" This surgery offers a safe, relatively simple procedure that has an

enormous impact on the health of the obese type 2 diabetic, " study

author Dr. B. Dixon, of Alfred Hospital in Melbourne, Australia,

told Reuters Health. He explained that " early, significant weight loss "

can cause a patient's diabetes to go into remission.

Type 2 diabetes occurs when the body can no longer properly use the

blood sugar-regulating hormone insulin. The condition is closely linked

to obesity.

To investigate the effects of the weight-loss surgery among these

patients, Dixon's team studied 50 individuals with type 2 diabetes who

weighed an average of 300 pounds, had significant disabilities and who

had attempted to lose weight by some other means for 5 or more years.

Three patients had the gastric band placed during open surgeries, while

the remaining 47 had the procedure done via laparoscopy.

One year after the surgery, 32 patients (64%) had experienced diabetes

remission, Dixon and colleague Dr. E. O'Brien report in the

February issue of Diabetes Care. Higher weight losses at follow-up and

shorter lengths of time with a diabetes diagnosis were both predictive

of remission, the report indicates.

In addition, although 34 patients (68%) had a history of high blood

pressure or were found to have high blood pressure before the operation,

27 of them reported improvements in their blood pressures at follow-up.

In fact, 15 of the 27 patients were no longer hypertensive.

The study participants also reported improvements in the quality of

their sleep and less sleepiness during the daytime, as well as less

depression, less pain, more energy and improved general health.

" Surgical weight loss therapy is effective at treating a broad range of

health problems experienced by (people) with diabetes, " Dixon said.

" The biggest problem, " he added, " is the need for reoperation if the

band slips. This requires another laparoscopic...operation to fix the

problem. "

Ten patients required such surgery after their band slipped, the report

indicates. Other surgical complications included the need for band

replacement for three patients after the original band eroded in the

stomach, and the need for minor surgery in two patients who experienced

leakage of the band's saline solution.

Among the three patients who had open operations, two had wound

infections and one required respiratory support.

Overall, however, Dixon's results represent " a fascinating first step

for people who have struggled for 5 years who remain severely obese, "

Dr. Vinicor, director of diabetes at the Centers for Disease

Control and Prevention in Atlanta, Georgia, told Reuters Health.

" These are people who are presumably at the end of their rope in their

ability to deal with their weight loss difficulties, " said Vinicor, who

was not involved in the research.

On the other hand, he pointed out, " it's a short-term study so far.

" Really, for any kind of procedure for people like this, accomplishing

endpoints after one year is not that big a deal, " Vinicor said. " It's

what happens after 2 or 3 years that makes a difference. "

SOURCE: Diabetes Care 2002;25:358-363.