Anti diabetes

Bariatric surgery as the best anti-diabetes

Bariatric surgery dramatically surpasses the standard treatment against type two diabetes according to new research.

In the first published study of its kind, researchers at the University Polyclinic Gemelli (Rome, Italy) and Weill Cornell Medical College Hospital New York Presbyterian (USA) found that bariatric surgery (gastric bypass, gastric banding, duodenal switch) greatly exceeds the standard medical treatment of severe type two diabetes.

These findings were published March 27, 2012 in the electronic version of the magazine " New England Journal of Medicine ".

The study authors report that most patients of bariatric surgery have been able to stop taking any diabetes medication, and maintaining remission (temporary reduction) of the disease during the study period (i.e. two years). Meanwhile, no patients who received standard medical treatment against diabetes could achieve the same thing.

"Although bariatric surgery is initially conceived as an anti-obesity treatment, it is now clear that it is an excellent approach for the treatment of diabetes and metabolic diseases, "said Dr. Francesco Rubino, the lead author of the study (responsible for cell surgery Gastrointestinal Metabolic, director of the Center for Metabolic and Diabetic Surgery at Presbyterian Hospital of New York, associate professor of surgery at Weill Cornell Medical College).

It is particularly difficult to treat obese patients with type two diabetes, because insulin therapy and other hypoglycemic drugs often cause further weight gain. In this study, the majority of patients who underwent surgery experienced improved blood sugar, decreased total cholesterol and triglyceride levels, and improved concentrations of HDL ("good cholesterol") . This suggests that bariatric surgery as a treatment of diabetes can reduce a cardiovascular risk of a patient.

"The unique ability of surgery to improve blood sugar and cholesterol and to help them lose weight because it is an ideal approach for obese patients with type two diabetes, "said the Doctor Gertrude Mingrone, Chief, Division of Obesity and Metabolic Diseases and Professor of Medicine at the Catholic University of Rome (Italy).
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For the study, researchers conducted a randomized controlled trial in patients aged 30 to 60 years.

This revise evaluated the lessening of diabetes in 60 ruthlessly obese patients (those with a BMI more than 35 and less than 40) and complex diabetes. Patients were erratically assigned to three groups:

Group A underwent a gastric bypass type Roux-en-Y,
Group B underwent biliopancreatic diversion (duodenal switch)
The C group received conventional drugs individualized, rigorous monitoring of their diet, and changed their lifestyle.

None of the patients in group C (medical therapy) could not go into remission since the beginning of the test.

In contrast, the remission of diabetes occurred and was maintained in 95% of patients in group B (Duodenal Switch) and in 75% of group A (bypass).

Remission is defined by a fasting glucose below 100 mg, and a hemoglobin A1c (HbA1c) of less than 6.5% for at least 12 months.

The study authors found that age, sex, preoperative BMI, how long the patient has diabetes, and weight loss after surgeries were not predictors of remission of diabetes.

"These results confirm that the effects of bariatric surgery on the type two diabetes can be attributed to mechanisms of surgery rather than the consequences of weight loss," said the Doctor Gertrude Mingrone. "To study the actual mechanisms by which surgery improves symptoms of diabetes may help to better understand this disease "she adds.

Today, bariatric surgeries are conducted only on those who are obese with a BMI above 35 and suffering from comorbidity (such as type two diabetes, for example). Individuals with a BMI of 40 or higher can be operated even without being diabetic.

"BMI is correlated with the risk of developing diabetes in the general population. In an individual, the BMI does not, however, says much about the severity of diabetes, its potential to cause complications or mechanisms the disease, "said Dr. Francesco Rubino.

"The study confirms that the use of strict limits of BMI to determine eligibility for surgery in patients with diabetes is medically inappropriate, and there is an urgent need to define better criteria for selecting patients, "he said.

Experimental studies previously conducted by Dr. Francesco Rubino showed that bypass operations gastrointestinal (such as gastric bypass and duodenal switch) activates direct mechanisms (which are independent of body weight) of diabetes control. These previous studies already support the use of surgery as a diabetes treatment, including patients less obese (BMI less than 35).

A randomized study comparing gastric bypass surgery with best medical treatment on patients with a BMI between 26 and 35 is currently underway at Weill Cornell Medical College of New York Presbyterian Hospital.

All patients analyzed in the current study were treated in Rome. Dr. Mingrone and his team of diabetes specialists were responsible for the medical treatment of patients in the study.

The Doctor Rubino, who also holds an academic assistant at the Catholic University of Rome, performed the laparoscopic gastric bypass. A team of surgeons at the Catholic University of Rome has made the Duodenal Switch.

The current study is part of a larger ongoing study, conducted jointly by the Catholic University of Rome and the Weill Cornell Medical College in New York.

In March 2007, the Catholic University of Rome hosted the "Summit of surgeries to treat diabetes." At this summit, a group of eminent international scholars already recommended to consider gastrointestinal surgery as intentionally treat diabetes type 2.

In 2007, Weill Cornell Medical College of New York Presbyterian Hospital created the Diabetes Surgery Center, the first academic program of its kind, as an effort to model the clinical practice, education and research around the specific purpose of treating diabetes surgically.

The Diabetes Surgery Center has organized since the first two editions of "World Congress on Interventional Therapies for Type 2 diabetes," which increased awareness in the world that surgery can treat diabetes.

It is estimated that 8.3% of the world population have typed two diabetes, according to statistics from the 2010 World Health Organization. This number should increase to 9.9% in 2030. Experts estimate that 23% of patients with morbid obesity also have typed two diabetes.

The costs associated with diabetes are a huge burden on health systems. Previous studies have suggested that bariatric surgery can be a cost-effective approach for obese diabetics.

Despite the potential gains, access to surgery for eligible persons is however very limited, and the obstacles are considerable. For example, less than 2% of qualified patients have access to bariatric surgery in the United States, and the figure is even lower in the world. The study's authors hope their study will change how bariatric surgery is perceived, and that physicians will consider surgery as a way to treat diabetes based on scientific evidence they did.

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