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Bariatric Surgery For Diabetes

Bariatric Surgery For Diabetes

CREATED Jul 9, 2014

CLEVELAND, Ohio (Ivanhoe Newswire) - Nearly 90 percent of people with type-two diabetes are obese and as more Americans gain weight, more will likely face a diabetes diagnosis. In fact, the American Diabetes Association predicts that one in three adults will have diabetes by the year 2050.

For years, we’ve heard about weight loss surgery and its effect on diabetes. Now, a new study is showing how well the popular surgery is working to stop this serious disease.

For most of his life, Tim Feree was overweight, tired and frustrated with his health, especially his type-two diabetes.

“I would check my blood sugar once or twice a day and take the pills and try to manage my diet,” Feree told Ivanhoe.

But nothing worked until Feree tried gastric bypass surgery.

“By losing the weight, the patient’s insulin resistance decreases and this results in a very rapid improvement in their blood sugar,” Philip Schauer, Director of Bariatric and Metabolic Institute at Cleveland Clinic, told Ivanhoe.

Schauer says gastric bypass also has an effect on a patient’s hormones which stimulates the pancreas to produce insulin.

“I have many patients who come to surgery who are on 100 units of insulin a day and before they leave the hospital, they are off all their insulin for the rest of their life,” Dr. Schauer explained.

A recent study found just five to 10 percent of patients who had bariatric surgery required insulin compared to 55 percent who received standard care. The surgery group also needed less blood pressure and cholesterol medications.

For Tim Feree, who said goodbye to insulin and his other medications, it’s a weight loss surgery that does much more.

“The day of surgery, I weighed 263 pounds. Today, I weigh about 195,” aaid Feree, “For me the surgery has been miraculous, it really has been.”

A recent study that appeared in the journal Diabetes Care found for the first time that bariatric surgery can also improve type-one diabetes, with some patients reducing their insulin intake by more than 60 percent.

RESEARCH SUMMARY

BARIATRIC SURGERY: Bariatric surgery is a collection of surgeries that deal with removing weight from someone’s body. One of the most common types of this surgery is gastric bypass, which makes changes to your digestive system in order to help you lose weight. Gastric bypass is typically the preferred bariatric surgery because it brings fewer complications from surgeons and has generated fewer complaints from patients compared to other weight loss surgeries. The first form of bariatric surgery was developed in 1954 which involved anastomosis of the upper and lower intestines. Over the last 50 years, bariatric surgery has changed drastically into a safer, more widely-known treatment for obesity. (Source: www.haysmed.com, www.mayclinic.org)

DIABETES: Diabetes is a disease that stems from high blood sugar levels. When the body gets a significant increase in blood sugar, insulin is released from the pancreas to lower the glucose level and normalize it. An insufficient production of insulin leads to hyperglycemia. Diabetes is a chronic disease that can lead to blindness, kidney failure and nerve damage. It can also lead to hardening of the arteries in the heart which can cause strokes and heart disease. Approximately 26 million Americans have diabetes while an estimated 7 million have diabetes and don’t even know it. (Source: www.medicinenet.com)

NEW FINDING: Bariatric surgery is now doing more than just helping with weight loss; it’s also helping to fight diabetes. New research has found that bariatric surgery not only helps eliminate type 2 diabetes symptoms in the short term but also causes remission for the disease in the long term. The new study tracked 343 patients with type 2 diabetes for two years and showed that 72 percent of those patients that had bariatric surgery were in remission for the disease. As the obesity epidemic grows in the United States, it’s important to know that bariatric surgery can help fight both obesity and diabetes at the same time. (Source: www.intelihealth.com)

INTERVIEW

Philip Schauer, MD, Director of Bariatric and Metabolic Institute at Cleveland Clinic talks about weight loss surgery and its effect on diabetes.

Why has bariatric surgery been more effective than medications for type 2 diabetes?

Dr. Schauer: Yes, most people with type 2 diabetes also struggle with their weight. In fact, about 80-90 percent of folks who have type 2 diabetes have obesity or even severe obesity which causes resistance to insulin. While medications can help to some degree in improving blood sugar, people that are obese and particularly severely obese, the medications can only do so much. Unfortunately, losing weight with diet and exercise and drug therapy is very difficult. So where surgery has an edge over medicine is very effective in diabetic patients at causing a significant amount of weight loss and keeping that weight off. By losing the weight, the patient’s insulin resistance decreases and this results in a very rapid improvement in their blood sugar.

What qualifies a patient for bariatric surgery for type 2 diabetes, like who would be a good candidate for this?

Dr. Schauer: Folks who would qualify for bariatric surgery who have diabetes would be folks that have a diagnosis of type 2 diabetes, and are either overweight or obese. It used to be that to qualify for bariatric surgery for weight loss, you had to have a BMI of 35 or greater which is roughly about 75 pounds overweight. Now, more and more evidence is showing that even people with relatively mild obesity, a BMI as low as 30, which is about 25 or 30 pounds overweight, these folks will equally benefit from bariatric surgery. Part of it is benefitting from the weight loss, but more important than that it’s benefitting from a dramatic improvement in blood sugar and reducing dependency on medications. Many folks can come off all their diabetic medications as a result of surgery and the other benefits are improving other aspects or other conditions that are commonly associated with diabetes, like high blood pressure and cholesterol; because the blood pressure and cholesterol tend to get better as well after surgery.

How long does it take to see results from the procedure?

Dr. Schauer: Folks that have diabetes can often see a result immediately. It’s really amazing. I have many patients who come to surgery who are on 100 units of insulin per day and before they leave the hospital, they’re off all their insulin for the rest of their life. We can see very dramatic improvement even before we see significant weight loss. The weight loss itself which is also an important driver in the benefit of surgery tends to occur over about 9 to 12 months following the surgery.

Why would we see the results for diabetes so quickly?

Dr. Schauer: The results of diabetes occur in part due to weight loss, but that’s a slow gradual effect. There is a second effect to surgery particularly with the gastric bypass that causes an immediate effect. To simplify it to a degree, we see hormonal changes occur. Hormones that are made in the gastrointestinal tract as a result of rerouting the intestinal tract are revved up in a big way and these hormones stimulate the pancreas to make insulin more effectively.

Why is gastric bypass better than some of the other surgeries like lap band for diabetes?

Dr. Schauer: There are several bariatric procedures that can improve diabetes Gastric bypass, sleeve gastrectomy, gastric banding, gastric plication, and even a procedure called duodenal switch; they’re all effective in causing weight loss to some degree. Of those, the gastric bypass not only causes weight loss, but it has a secondary hormonal affect that revs up hormones made in the gastrointestinal tract to directly stimulate the pancreas to produce its own insulin. We have a one- two punch here with the gastric bypass and that’s why the remission rate with gastric bypass can be as high as 75 percent in some patients, whereas with the other procedures it’s definitely lower.

What are some of the long term dangers of the procedure?

Dr. Schauer: All of these bariatric procedures have improved dramatically over the past decade in terms of the safety and the risk of complications. Most of that is credited to the minimally invasive or laparoscopic surgery which makes these operations less invasive. The average stay in the hospital is about two days and back to work in about two weeks. The procedures have really gotten safer. So as a comparison, the gastric bypass is about as safe as having your appendix out, having gallbladder surgery, or having a hysterectomy. It’s really come down in terms of its complication rates to be considered among many others who have common, safe procedures.

What’s the failure rate for bariatric surgery and how does it compare to other treatments specifically for diabetes?

Dr. Schauer: Fortunately, the vast majority of folks who have bariatric surgery lose a lot of weight and keep that weight off long term to a much greater extent than we see with drug therapy or diet and exercise programs. However, it’s not 100 percent effective. I would say that about 90 percent of folks who have bariatric surgery, particularly the gastric bypass procedure, will lose a majority of their excess body weight and maintain that weight loss for five years or more. The folks that regain some weight back or have poor weight loss to begin with, can have doctors work with them to lower that probability of having a bad outcome.

What seems to be the key for which patients will benefit the most and which ones won’t?

Dr. Schauer: Patients who are motivated, who follow doctors recommendations, folks that continue with good lifestyle modification including good dietary eating habits, exercising and getting at least two hours to two and a half hours of exercise per week. Those are actually good predictors of long term success. Another pretty good predictor is people who have surgery earlier in their life span. Folks in their 20s and 30s who are overweight, if they get the surgery earlier, they’re more likely to lose most of the weight and keep it off and avoid these other chronic conditions of obesity such as sleep apnea, hypertension, heart disease, heart attack, stroke, and so forth.

How many people gain the weight back and have diabetes come back?

Dr. Schauer: Yes, in terms of patients who have had the surgery and initially have had very good success at weight loss, about 10 percent of folks may gain a significant amount of weight back. That is much less than we see with diet and other exercise based programs and there are interventions that can occur that can minimize that or get patients back to their original weight loss after surgery.

Okay.

Dr. Schauer: In general, good candidates for bariatric surgery are individuals who have a significant amount of obesity, who have 75 pounds or greater of excess body weight who have struggled with diet and exercise type programs and have gone nowhere. The next obvious step is to go with surgery which has a much greater probability of long term success and improving ones quality of life. It also prevents a lot of serious diseases from developing such as diabetes, high blood pressure, heart disease and sleep apnea. Another really important group were folks that currently have diabetes because this surgery is so extremely effective at improving blood sugar, getting patients off both pills and insulin shots and reducing these very dreaded long term complications of diabetes; the blindness, kidney failure, heart attack, stroke and amputations. For a person that has diabetes and obesity, surgery is becoming more and more the go-to intervention.

FOR MORE INFORMATION, PLEASE CONTACT:

Andrea Pacetti
Media Relations Manager
Cleveland Clinic
Phone: (216) 316-3040
Phone: (216) 444-8168
pacetta@ccf.org