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Diabetes Improves After Obesity Surgery

Gastric Bypass Surgery May Be Realistic Option for Improvement of

Diabetes Complications

By Jeanie Lerche

WebMD Medical News Reviewed By Brunilda Nazario, MD

on Monday, October 06, 2003

Oct. 6, 2003 -- Gastric bypass surgery -- often a last resort for

severely obese people -- can vastly improve diabetes, a new study

shows.

The finding adds yet another benefit to this weight-loss procedure.

Chest pain, shortness of breath, high blood pressure, and sleep

problems also drop substantially, researchers have found.

However, the effects of gastric bypass surgery on diabetes have not

received much attention, writes lead researcher Philip R. Schauer,

MD, director of bariatric surgery at the University of Pittsburgh

Medical Center. His report appears in the current issue of ls of

Surgery.

Even though diabetes is usually treated with medication and insulin,

eventually it can progress to kidney failure, blindness, erectile

dysfunction, even amputation, says Schauer.

'Very Dramatic' Diabetes Results

But his study showed the procedure can actually " cure " diabetes,

Schauer tells WebMD. " Overall, after surgery these patients had

complete resolution of diabetes -- very dramatic. "

Marks, MD, a diabetes specialist at the University of Miami

School of Medicine, has counseled a number of gastric bypass

patients. " Gastric surgery is a technique for people have tried

everything else to lose weight and not been successful, " Marks tells

WebMD. " I recommend it as an option. It can work. " She, too, has seen

remarkable effects on diabetes.

However, if patients regain weight, " it also means their diabetes

could come back, " Suzanne Gebhart, MD, a diabetes expert with Emory

University School of Medicine in Atlanta, tells WebMD.

All the 144 people in Schauer's study weighed over 300 pounds before

gastric bypass surgery and were considered morbidly obese. Most were

women with an average age of 40.

The surgery involves restricting the size of the stomach by stapling

most of it shut, so that patients feel satisfied with small amounts

of food. And some of the food isn't absorbed. These two mechanisms

allow patients to lose weight.

The study's patients all had some degree or risk of type 2 diabetes,

ranging from very mild to moderate to severe, he says. Some were

taking no diabetes medications; others were taking several

prescriptions plus insulin. Some patients had had diabetes for less

than five years, some for more than 10 years.

Normal Blood Sugar, Fewer Meds

Schauer tracked the patients' weight loss and their diabetes during

the five years after gastric bypass surgery. Overall, they lost about

60% of their body fat -- nearly 100 pounds apiece.

The women's fasting glucose levels, an indicator for diabetes, got

much better:

For 83% of the women, glucose levels returned to normal levels; for

17%, there was marked improvement.

80% of patients reduced the amount of diabetes medications and 79%

required less insulin.

" Even patients with very severe disease, who required more than 100

units of insulin every day for more than 10 years, were cured, "

Schauer tells WebMD.

In fact, 30% of patients could quit diabetes medications immediately

after hospital discharge, even before they lost much weight.

The most dramatic changes in improvement in their diabetes was seen

in patients who had had diabetes for shorter periods or less severe

diabetes.

Diabetes-related complications also improved significantly: Nerve

damage was present in 47 patients prior to surgery, after surgery 50%

of patients reported improvement of symptoms; 18% of the men with

erectile dysfunction had improvements.

Other health improvements: 89% had improved blood pressure; 78% had

better cholesterol; 80% got better sleep because their obstructive

sleep apnea improved. The sleep-related condition occurs when

breathing temporarily -- and frequently -- stops because neck

structures around the breathing pipe collapse, usually because of

excess weight.

Gastric Bypass Surgery: Truly a Cure?

" One of the big messages here -- the major message -- is that early

surgical intervention in these patients is most important, " he tells

WebMD. " If we catch them early, almost all of them will be cured. "

Also, patients who lost a modest amount of weight did quite well, he

points out. " This brings up a very interesting question, is it the

weight loss or something else that's going on? "

The findings add insight to the insulin-production process, Schauer

says. " We're still very early in understanding role the gut plays in

glucose metabolism and onset of diabetes. "

Here's what may be happening: After gastric bypass surgery, food

bypasses the stomach and upper intestine. This bypass seems to affect

hormones produced by the upper intestines and islet cells produced by

the pancreas, which is key in producing insulin. All these mechanisms

play into onset of diabetes, Schauer explains.

These factors also affect the amount of diabetes medication patients

are taking, he adds. " Some were taking 100 units insulin a day, and

taking three to five oral medications, " he tells WebMD.

" After surgery, there was a dramatic reduction in the number of

medications they were taking. The vast majority was able to get rid

of all their medications. "

In the five-year follow-up, some patients had " a modest regain of

weight, which is typical, " Schauer admits. However, other studies of

gastric bypass studies have shown that 15 years down the road,

patients will keep most the weight off, he adds.

" Most patients do quite well with gastric bypass surgery, Marks tells

WebMD. " Even those people who had not yet developed diabetes

improved. That's very important, that even when blood sugars are

within the normal range, there can be some improvement. "

In dollars-and-cents terms, it makes sense, she adds. " The decreased

use of diabetes medications may make the surgery a cost-effective

intervention. "