Weight Loss Surgery for Diabetics Columbia SC
"Diabetes Surgery" for Type 2?
A trial underway at New York-Presbyterian Hospital/Weill Cornell Medical Center is exploring whether surgery may be the best option to treat diabetes in these patients. Until now, bariatric surgery was recommended only for individuals who are severely or morbidly obese, which means having a body mass index (BMI) of 35 or higher. After surgery, diabetic patients have improved blood sugar levels, a reduced need for medication, and a decreased risk for diabetes-related deaths. But the new research is looking at individuals whose BMI is as low as 26. (Those whose weight is normal have a BMI between 19 and 25, according to Medical News Today, and overweight individuals have a BMI that ranges from 26 to 29.) The current research at Weill Cornell, one of the first studies to test surgery as a treatment for Type 2 diabetes, is focusing on 50 type 2 diabetics who will either get surgery (the Roux-en-Y Gastric Bypass) or medical therapy. Both groups will receive counseling on diet, exercise, and lifestyle modification techniques. Mitchell Roslin, MD, chief of obesity surgery at Lenox Hill Hospital in New York City, notes that bariatric surgery can improve diabetes-related symptoms in 90 percent of diabetics who are morbidly obese. He says that the improvement is not just due to weight loss that occurs following surgery. "The improvement in insulin sensitivity exceeds what would be predicted by weight loss alone," Roslin says. "So there is probably something about the way we are rearranging the GI tract that improves the diabetes." "There are some interesting aspects to this study," says Vivek N. Prachand, MD, of the University of Chicago. "It's brought to the forefront how effective this surgery is, and how you can have either remission or significant improvement in diabetes after surgery." It's known that patients who undergo bariatric surgery and lose a substantial amount of weight usually have a dramatic improvement in their diabetes, says Francesco Rubino, MD, chief of metabolic surgery at Weill Cornell Medical College, who is conducting the research with a team of co-investigators. "We have found that the effect of weight loss on diabetes is not only due to the weight loss but to a complex mechanism that changes the way the gastrointestinal tract signals," he says. "Experimental studies suggest that the surgery could even change the endocrine function of the GI tract." The current study, Rubino says, "will help us understand the causes behind diabetes and will help us know if the efficacy of surgery is so profound that it is even better than high-level medical treatment." And, Rubino says, his research may help doctors figure out a better criteria than BMI to help them choose surgical candidates. "BMI does not accurately define the severity of diabetes," he says. Right now, since insurance companies base whether or not they'll pay for surgery on a patient's BMI, the operation typically is not covered for patients who are jus... |
Weight Loss Surgery for Diabetics
If you're overweight and just can't seem to shed the unwanted pounds, you may be wondering whether surgery could be helpful in your quest to lose weight and get your blood sugar back in the normal range. Before you make a decision, weigh all the options. Many choices are available today to diabetics who opt for weight loss surgery, each with pros and cons. Here's a rundown of what surgical options are out there. For each, the success rate means how many patients successfully lost and kept off the weight over time. Gastric bypass surgery: The procedure involves stapling the stomach, creating a little pouch and a passageway for the food to bypass part of the small intestine. This is the "gold standard" of weight loss surgeries, says Vadim Sherman, MD, a bariatric surgeon at Methodist Hospital in Houston, Texas. The success rate is high, about 70 to 80 percent of patients who have gastric bypass surgery continue to keep off the weight for 20 to 30 years, he says. Sherman says gastric bypass "has been shown to be the only surgery to resolve diabetes before any weight loss has even occurred." And, he adds, sometimes he sees patients have normal blood sugars even before they leave the hospital. Gastric band surgery, (also known as Lap-Band adjustable gastric banding): This option is often a good choice for a recently diagnosed diabetic, says Mitchell Roslin, MD, chief of bariatric surgery at Northern Westchester Hospital in Mt. Kisco, New York. To perform this, an inflatable band is put into place and divides the stomach into two parts as it wraps around the upper part. Once pulled tight, the band restricts the amount of food a person can eat. "We put a belt on the stomach that has a balloon inside and the balloon squeezes the stomach," Roslin explains. While it's simpler than the other surgeries and has a lower rate of complications, it's not as effective. Individuals who have the gastric band surgery tend to lose less weight and to lose it more slowly than those who have the more radical procedures. The success rate is about 50 to 60 percent, Roslin says. This procedure also has the highest reoperation rate, he adds. Duodenal switch: This is a more intense operation with a higher rate of complications. In this procedure, about 80 percent of the stomach is removed. A valve that lets food into the small intestine remains, as does a portion of the small intestine. But the majority of the intestine is bypassed during the operation, which connects the intestine's end portion to the duodenum near the stomach. "Technically it is a more demanding operation but it has a high success rate - about 95 percent," Roslin says. "And it can be done laparascopically." Patients who've had this procedure are at a higher than average risk of malnutrition, and some report diarrhea as well, Sherman explains. Sleeve gastrectomy: With this procedure, in order to limit the number of calories your body can absorb, the stomach's structure is m... |
