Bariatric surgery may be the best treatment for obese people who suffer from Type 2 diabetes, according to a new study published in the Archives of Surgery, which found that the procedure improved diabetes outcomes when compared to patients who received standard medication therapy for the disease.
Researchers from the University of Rome in Italy conducted a study that included 60 morbidly obese patients with Type 2 diabetes. Half the patients underwent sleeve gastrectomy, a surgical procedure in which the stomach is reduced to about 25 percent of its original size. The other half of the study participants received conventional medical therapy for type 2 diabetes.
Eighty percent of patients who underwent the surgery were cured of diabetes 18 months after the surgery, and their BMI, which averaged 41.3 before the procedure among the participants, was reduced to 28.3 after the study period. A BMI of 30 or above is considered obese. But patients who received medication for the disease did not show improvement, and remained diabetic during and after the study period.
Researchers also noted that patients who underwent surgery saw improvements in blood pressure, cholesterol levels and obstructive sleep apnea.
Medically treated patients required more medication for blood pressure and cholesterol control over time.
"Midterm and long-term results are needed to confirm the positive effect (remission and/or improvement) of [laparoscopic sleeve gastrectomy] on diabetes and, overall, on the chronic complications of the disease," the authors wrote in the study. "Most importantly, the longer-term results will allow us to compare the costs and benefits of bariatric surgery vs conventional medical treatments."
But the patients in the study who simply received medication for treatment were not newly diagnosed patients, and Dr. Vivian Fonseca, president of the division of Medicine and Science with the American Diabetes Association, said it would have been better to see how newly diagnosed patients responded to the medications versus the bariatric candidates.
"They selected people who were already obviously not doing well on medication therapy, so it's unrealistic expectation that the medication therapy is going to be able to stop after a while," Fonseca said. "It would have been better to see newly diagnosed patients who seemed to be doing well on medications."
The Italian study comes on the heels of two studies published last month that found bariatric surgery lowers blood sugar levels almost immediately in patients with type 2 diabetes even before patients lost weight. One study found 42 percent of patients who underwent the gastric procedure showed no evidence of diabetes one year later, compared to 12 percent who received medication.
There are currently 25.8 million adults and children in the United States living with diabetes, according to the American Diabetes Association, and about 1.9 million new cases of diabetes were diagnosed in people 20 and older in 2010.
By 2020, the ADA estimates that the annual cost in caring for diabetic patients will near $192 billion. A typical bariatric surgery runs between $10,000 and $15,000 in the United States.
Only about 2 percent of these patients are currently treated with bariatric surgeries, but experts say the cost-effectiveness must be studied further to understand whether these surgeries are appropriate for the masses.
"There are a variety of treatments available in terms of altering the GI tract," said Dr. Gerald Bernstein, director of the Diabetes Management Program at the Friedman Diabetes Institute at New York's Beth Israel Medical Center.
Nevertheless, Bernstein said, given the tens of millions of people who have diabetes, it is economically impossible to offer the surgery to everyone. But it is important for primary care physicians, endocrinologists and surgeons to work together to decide which Type 2 diabetes patients would benefit most from these surgeries.
"Doctors need to be sure they find patients who will make this surgery worthwhile," Bernstein said. "If you're going to do something like this that significantly changes the body, you need to make sure they have the motivation to follow doctor's recommendations."
"Right now, this is another tool and option in the arsenal for diabetes treatment," he said.