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Bariatric Surgery Cures Adult-Onset Diabetes; Is This a Problem?

Posted Aug 25 2010 12:00am

Three years ago, I discussed early reports that bariatric surgery can cure adult-onset diabetes through a mechanism not solely related to weight loss (see: "Curing" Diabetes with Bariatric Surgery ). Now comes more information confirming these initial observations (see: Study: Surgery May Reduce Diabetics' Need for Drugs ; subscription required). Below is an excerpt from the article

The majority of people with diabetes who had bariatric surgery to lose weight were able to stop taking their diabetes medications, which led to a significant decline in health-care costs, according to a [recent] study....Researchers at Johns Hopkins in Baltimore, looked at 2,235 adults who had the stomach-reducing surgery and who also had Type 2 diabetes, a common form of the disease often associated with weight gain. Six months after surgery, nearly 75% of patients had eliminated their diabetes medications and after two years 84.5% of patients were off medicine....Many patients were able to stop taking their medications almost immediately after surgery and before they'd lost large amounts of weight, backing theories that stomach hormones altered by surgery are better able to control blood glucose levels than weight loss alone....About 86% of the patients, who were covered by Blue Cross and Blue Shield insurance, were on at least one diabetes medication before surgery, with an average of 4.4 medications per patient. About 23% of patients were on insulin.

Who would have thought, say, five years ago that we would have been discussing a surgical cure for adult-onset diabetes? However, we still need to study this issue on an even longer-term basis. It's possible that the body may adapt to the surgery-induced hormonal effects and that the disease may recur at a later time. However and as noted above, the beneficial effects do appear to last for more than two years for most patients. We  have known for many years that weight loss can cure or ameliorate adult-onset diabetes. For example, the metabolic syndrome is a pre-diabetic state that can be cured with weight loss (see: Metabolic Syndrome: The Problem You May Never Have Heard About ; Visfatin, A "Belly Fat" Hormone, and Its Relationship to the Metabolic Syndrome ).

Her's something to keep in mind. A physician told me recently that some of his patients do not show improvements in their lipid "numbers" when he prescribes statins for them. It turns out that many of them are unable or unwilling to alter their diets to correct a lipid problem. They view the statin treatment as a "quick fix" which permits them to avoid making the necessary lifestyle changes. I am therefore nervous about the use of bariatric surgery to cure Type 2 diabetes. Here's the choice being offered to these patients in my opinion: (1) surgical intervention with its attendant risks to create a greatly altered physiologic state and uncertain long-term consequences; (2) increased physical activity and an altered diet leading to gradual weight loss with certain long-term gains.

For me the choice would be obvious. Opt for less intervention. However and with bariatric surgery, the insurance companies gain with long-term reduced costs and hospitals and surgeons gain with the revenue from the procedures. With these types of returns now available for the healthcare establishment, I think that I know what the future holds. All of the incentives seem to be lined up in favor of bariatric surgery.

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