Surgery considered as diabetes cure

Bariatric surgery, the most effective and lasting weight-loss treatment, could also become one of the most effective treatments for conditions such as type 2 diabetes, hypertension and high cholesterol.

A group of international doctors treating metabolic diseases say there is increasing evidence that surgically shrinking the stomach and removing sections of the small intestine not only achieves rapid weight loss, but it also alters, at a cellular level, the way the body converts food into energy.

Studies published in the Annals of Surgery and Journal of the American Medical Association found that more than 75% of diabetics receiving bariatric surgery see blood-sugar levels return to normal and no longer need to take insulin or other medications.

“Surgery for severe obesity goes way beyond weight loss,” said Dr. Kelvin Higa, a UCSF-Fresno clinical professor of surgery who practices at Fresno Heart & Surgical Hospital and at Clovis Community Medical Center. “We’re seeing a tremendous response to diabetes with gastric bypass surgery and we've known about it for decades.”

Dr. Higa was one of a handful of American surgeons invited to an international conference in Rome this spring to take a closer look at hormonal changes and what’s happening on a cellular level when parts of the intestine are removed. The group of doctors, mostly endocrinologists and others who treat metabolic disorders, decided further study is needed. However, they did agree that bariatric surgery could immediately benefit type 2 diabetics who have a body mass index (BMI) as low as 30 – much less than the current requirement of being morbidly obese with a BMI above 40.

“Diabetes is growing rapidly – as fast as obesity is,” Dr. Higa said. “And many of the medications they use to control diabetes makes

Dr. Kelvin Higa

patients gain weight.

Diabetes is a killer as much as obesity is and they often go hand-in-hand.”

About 21 million people nationwide have type 2 diabetes, according to the American Diabetes Association. Another 54 million have pre-diabetes. In a report made to Congress this summer, it was estimated that one of every eight federal health-care dollars is spent treating people with diabetes. Nationwide, the per capita health care costs for diabetes is now more than $13,000 a year, compared to less than $3,000 a year per person without diabetes. And people with diabetes are at greater risk of heart disease, high blood pressure, stroke, blindness, amputation and kidney disease.

"The idea that you could induce long-term remission in diabetic patients without medication is unprecedented," Francesco Rubino, a surgeon at Catholic University in Rome, declared in a Wall Street Journal article. Doctors at the Rome conference made plans to establish a task force with endocrinologists, surgeons, clinical investigators and bioethicists to study the development of surgery treatments for diabetes.

To reflect the expanded view about weight-loss surgery, the 25-year-old association for bariatric health professionals changed its name in mid-August, said Dr. Higa, president of the newly named American Society for Metabloic & Bariatric Surgery. “People generally don’t think of surgery as a treatment for diabetes or high blood pressure, but it is, and we expect metabolic surgery to play an ever increasing role in managing these diseases.”

Dr. Higa said that view wasn’t universal and some endocrinologists argue that there are effective drug treatments that don’t carry the same risks or possibility of complications as surgery. He countered that bariatric surgery has become much safer in the last decade and now carries the same risk of mortality as orthopedic surgery and much less risk than a heart bypass.

“As our therapies become safer it should by applied to those who are in less risky situations as well,” Dr. Higa said. “Bariatric surgery is life-saving. There are no good alternatives for many people – none that can equal the effects of bariatric surgery. Diets and medications just don’t work as well. If the treatment is so untenable that patients don’t comply then maybe there’s an issue with the treatment.”


This story was reported by Erin Kennedy. She can be reached at ekennedy@communitymedical.org.

Thursday, September 06, 2007