Sunday, December 30, 2012

Bariatric Surgery Is Not Always a Cure for Type ll Diabetes

As we all know, bariatric surgery is increasingly being used to treat obesity. It is being used because the surgery is effective in combating the disease. Bariatric surgery has also been found to be beneficial in treating type 2 diabetes. But not all forms of the surgery are equally successful, and even the most effective bariatric surgical method may not resolve the disease long term for most persons with type 2 diabetes.

The three most common types of bariatric surgery are gastric bypass surgery, laparoscopic sleeve gastrectomy (LSG), and the lap band. While gastric bypass is the most studied form of the surgery, LSG and the lap band have both been considered, and investigated, as a surgical treatment for type 2 diabetes.

A study abstracted on Pubmed indicated that over a ten year period, only about a third of people with the disease experienced a durable remission. The study was conducted by the Group Health Research Institute located in Seattle, WA.  The study looked at "4,434 adults with uncontrolled or medication-controlled type 2 diabetes who had gastric bypass." Two thirds of the subjects experienced remission, but for a third of these subjects the disease returned within five years of the surgery.

LSG (laparoscopic sleeve gastrectomy) is coming into its own as a viable form of bariatric surgery. And a recent study has shown that the surgery can resolve type 2 diabetes. "In 13 cases of type 2 diabetes mellitus, 7 patients (53.8%, 7/13) were weaned off hypoglycemic agents or insulin. In 11 cases of hypertension, 5 required no medications (45.5%, 5/11). The remission rate was both 100%." The researchers concluded that LSG "can cure or improve type 2 diabetes mellitus."

It should be noted, however, that the type 2 diabetes LSG group was small, and that the period following the LSG surgery was only a year. Looking at type 2 diabetes patients for a ten year period may give less positive results similar to those received from the gastric bypass study referenced above. So with respect to LSG, more researched is needed to determine if the surgery effectively treats type 2 diabetes.

And concerning the lap band, a recent study described on Pubmed showed that type 2 "Diabetes resolution, defined by HbA1c less than 6.5% and taking no medications, occurred in 14 (16%) [of the] cases..." This was a relatively small number of patients experiencing remission related to lab band surgery.

So based on the above mentioned studies, bariatric surgery is an option for the treatment of type 2 diabetes. However, in many cases, there is a good chance the surgery will not be a long term cure for the disease.  Further, results from the studies show why collaboration between overweight type 2 diabetes patients, non surgical weight loss professionals, and bariatric surgeons is important in deciding on the proper treatment for the patients.

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