Bariatric Surgery Cuts Type 2 Diabetes

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Type 2 diabetes, which affects nearly 26 million Americans, may have met its match. And Cris Iaboni, a 48-year-old mother of two from Bethany, Conn., may be one of the first victors.

Diagnosed when she was 38 years old, Iaboni was fighting a losing battle with her diabetes. With the help of her endocrinologists, she did everything she could, aggressively limiting carbohydrates, exercising and taking her medications. But her diabetes only got worse. And losing weight, the basic advice for diabetics, wasn't helping.

"Every time my insulin dose went up, I gained more weight, which made my diabetes worse," said Iaboni. "I was losing hope"

In 2009, with nothing to lose, Iaboni Googled "cure for diabetes" and came across a trial that posed a daring question: What if you could get rid of both obesity and diabetes with one surgical procedure?

The results of two separate trials published today in the New England Journal of Medicine showed for the first time that bariatric surgery can lower blood sugar levels immediately in patients with type 2 diabetes, even before the weight comes off. The surgery limits the amount of food a person can eat, and the amount of calories they absorb.

"Bariatric surgery should not be considered just weight loss surgery," said study author Dr. Francesco Rubino of Weill Medical College of Cornell University, "but a means to treat diabetes and metabolic disease."

Rubino and co-authors at the Catholic University in Rome enrolled obese patients to undergo either intense drug therapy for their diabetes or bariatric surgery. Of patients who had Roux-En-Y surgery, the most common type of bariatric surgery in the United States, 75 percent showed no evidence of diabetes and were off their medications. The improvement started15 days after surgery. No one in the drug treatment group was free of diabetes.

A similar study from the Cleveland Clinic found that 42 percent of patients who underwent gastric bypass surgery showed no evidence of diabetes one year later, compared with 12 percent of patients who received drug therapy.

"For about a century, we have been treating diabetes with pills and injections, and this is one of the first studies to show that surgical therapy may, at least in some patients, be much more effective than the polypharmacy approach to treating this disease," said study author Dr. Philip Schauer at the Cleveland Clinic Bariatric and Metabolic Institute.

The surgery also triggered a drop in triglyceride levels, and levels of good cholesterol went up.

"Currently less than 2 percent of patients are treated with bariatric or metabolic surgery," said Dr. Joel Zonszein, director of the Clinical Diabetes Center at the University Hospital of the Albert Einstein College of Medicine, who was not involved in the studies. "Many more people can benefit."

Dr. Christopher Cannon, a professor of medicine at Brigham and Women's Hospital, said the study is "further indication that bariatric surgery is not cosmetic, but a real treatment for heart disease."

Dr. Chip Lavie, a professor of medicine at the John Ochsner Heart and Vascular Institute, said major efforts to prevent and control type 2 diabetes and its complications "are desperately needed. … Obviously, it would be better to accomplish this with diet and exercise, but unfortunately, this has not worked well for so many people, so more drastic efforts are needed," he said.

As to whether bariatric surgery is the answer, more research into its cost-effectiveness is needed.

"Given that there are millions of obese people with diabetes, it is physically and economically impractical to provide this technology for all," said Dr. Gerald Bernstein, director of the Diabetes Management Program at the Friedman Diabetes Institute at New York's Beth Israel Medical Center.

Iaboni was off all of her diabetes medications two months after the surgery. Now, three years later, she no longer takes medications for cholesterol and high blood pressure.

"I haven't felt this good in 10 years," she said, adding that the medical community should keep "an open mind" about the value of gastric bypass surgery in treating diabetes.

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