New research suggests gastric bypass surgery as an effective treatment for type 2 diabetes
Dr. Florencia Halperin
“I’ve always been interested in the connection between obesity and diabetes,” says Dr. Halperin. She explains, “We have so many patients now who have both obesity and type 2 diabetes. Surgery has come on the scene as a very good treatment for obesity. Very early on after the gastric bypass surgery, doctors taking care of those patients noted that people who had diabetes, who got the surgery for weight loss, had very significant improvements in their diabetes. The really interesting thing is that the diabetes gets better very quickly, before they lose significant weight. There seems to be something about the surgery that may have a specific effect on diabetes, not just on weight.”
“A key finding by researchers in this field early on,” says Dr. Halperin “was that about 30 percent of people were going home after surgery off insulin, after an average hospital stay of about three days. That’s before they were significantly losing weight. And that doesn’t happen when people go into the hospital for surgeries for their gallbladder or something else. So there seems to be something unique about this surgery.” This result may be from a range of factors including hormonal changes that take place after surgery.
In her study, Dr. Halperin found that at the one-year mark the proportion of patients achieving HbA1c below 6.5 percent and fasting glucose below 126 mg/dL was higher following surgery (58 percent) than the medical and weight management program (16 percent). Other outcomes, including weight, waist circumference, fat mass, lean mass, blood pressure and triglyceride levels decreased and high-density lipoprotein cholesterol increased more after gastric bypass surgery compared with the medical and weight management program. The study also considered the results of quality-of-life questionnaires. At the one-year mark, improvements in Short Form-36 physical and mental health scores and Problem Areas in Diabetes scores did not differ significantly between groups. The Impact of Weight on Quality of Life–Lite score improved more with the surgery group and correlated with greater weight loss compared with the medical and weight management program group.
“There are still a lot of things that we don’t understand,” cautions Dr. Halperin. More and more, gastric bypass is being considered a metabolic surgery rather than just weight loss surgery. As a result, patients with type 2 diabetes may have more treatment options in the future. “It’s really exciting that people have options, because surgery is not right for everybody and an intensive weekly medical weight loss program is not right for everybody,” says Dr. Halperin. With continued research, the hope is to better understand which treatment option is best for the individual patient.