Stomach Stapling Surgery Puts Diabetes on Hold, Studies Find
Diabetes runs in Heather Britton’s family. Her mother died of complications at age 63, and over a dozen other relatives have the disease. Until a few years ago, Britton says she was convinced it would kill her too.
In January 2009, the Bay Village, Ohio, woman underwent gastric bypass surgery as part of a study by the Cleveland Clinic to see if the operation can help severe diabetes. Within months, she lost 80 pounds and stopped taking drugs for diabetes, high cholesterol, and high blood pressure.
The clinic’s results in 150 patients, reported today at the American College of Cardiology meeting in Chicago, found that obesity surgery normalizes blood-sugar levels for a year in overweight people with diabetes, outpacing the best drug therapy and potentially changing medical practice, the researchers said. A second trial in 60 patients found diabetes remission rates as high as 95 percent two years after surgery.
“It has been amazing,” Britton, 53, said by telephone, adding that her blood sugar is normal and she has kept almost all the weight off. “There has been a total change to my life.”
The studies are among the first to directly compare the effect of obesity surgery to intensive drug treatment, wrote Paul Zimmet, of the Baker IDI Heart and Diabetes Institute in Australia, and George Alberti, of Kings College Hospital in London, in an editorial accompanying the research in the New England Journal of Medicine.
The findings “are likely to have a major effect on future diabetes treatment,” they concluded.
Two Types of Surgery
Two types of surgery were studied. Gastric bypass, the most common, limits food intake to a pouch about the size of a golf ball at the top of the stomach. In so-called sleeve gastrectomy, surgeons staple the stomach to reduce its volume by about 75 percent, from the size of a football to that of a banana.
About 200,000 Americans get obesity surgery every year, a market mostly driven by severely heavy people. If confirmed, the Cleveland Clinic study could expand use of the surgery to a wide group of moderately obese people with uncontrolled diabetes, said Philip Schauer, a surgeon at the center who led the study, in a telephone interview.
“For people on seven, eight, nine medications who aren’t getting better, their doctors should be talking to them about this other option,” Schauer said. “Although it has risks, the potential benefits are quite remarkable.”
One in three patients studied in the Cleveland Clinic research wouldn’t have been big enough to qualify for obesity surgery under current U.S. guidelines.
Normal Blood Sugar
About 42 percent of patients who got gastric bypass had normal blood sugar levels a year later, compared with 12 percent of patients on drugs, according to results. Almost 37 percent of patients who got a second type of obesity operation called a sleeve gastrectomy had normal blood-sugar levels a year later.
While four patients in the Cleveland Clinic study required re-operations, there were no deaths or life-threatening complications. The study was paid for by Johnson & Johnson (JNJ), which makes surgical staples.
The second study, by researchers at Università Cattolica del Sacro Cuore in Rome and New York Presbyterian Hospital in Manhattan, found even more impressive results. About 75 percent of patients who got gastric bypass and 95 percent who got a second type of surgery were in remission two years later.
The European research also studied used an aggressive operation called a biliopancreatic diversion that removes about 80 percent of the stomach and bypasses most of the intestines to reduce the amount of food absorption in the intestines.
In the past, physicians who treat diabetics have been resistant to considering surgery as an option for patients uncontrolled on multiple medicines, said Maria Collazo-Clavell, an endocrinologist at Mayo Clinic in Rochester, Minnesota.
The studies show that there should also be a discussion about the possibilities of bariatric surgery, she said. Still, doctors will need to weigh the risks and benefits, as surgery can cause infections and in rare cases, death, she said in a telephone interview.
For Britton, a programmer at Hewlett-Packard Co. (HP) learning to eat again after she underwent surgery was “a major struggle,” she said.
She now eats five or six mini-meals each day, and must take supplements to make sure she is getting enough nutrients. Some “trigger foods” still make her sick, she said.
It’s worth it, Britton said. “My health has totally turned around. It is kind of like a rebirth.”
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