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[IP] Diabetes Improves After Obesity Surgery

Original article:


Diabetes Improves After Obesity Surgery

      By Jeanie Lerche Davis
      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 Annals 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."

Jennifer 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

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

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

  a.. For 83% of the women, glucose levels returned to normal levels; for
17%, there was marked improvement.
  b.. 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

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."


SOURCES: Schauer, P. Annals of Surgery, Oct. 2003; vol 238: pp 467-485.
Philip R. Schauer, MD, director, bariatric surgery, University of Pittsburgh
Medical Center. Suzanne Gebhart, MD, Emory University School of Medicine,
Atlanta. Jennifer Marks, MD, endocrinologist, University of Miami School of

) 2003 WebMD Inc. All rights reserved.

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