Public release date: 2-Oct-2003

Contact: Frank Raczkiewicz
RaczkiewiczFA@upmc.edu
412-647-3555
University of Pittsburgh Medical Center

Gastric bypass surgery resolves or improves diabetes in most patients,
reports Pittsburgh study
PITTSBURGH, Oct. 2 – A study of obese people with type 2 diabetes who
underwent laparoscopic gastric bypass surgery (LGBP) found that 83
percent of them experienced a resolution of their disease.
The study, from the University of Pittsburgh School of Medicine, is in
the October issue of the journal Annals of Surgery.

The study also found that clinical resolution or improvement in
diabetes occurred in all patients, but patients with the shortest
duration and mildest form of type 2 diabetes had a higher rate of
resolution after the surgery. During the study there were no new
occurrences or recurrences of type 2 diabetes in 310 patient years of
follow-up. Nearly one third of patients permanently discontinued
anti-diabetic medications after discharge from the hospital – even
before significant weight loss could occur.

According to Philip Schauer, M.D., director of bariatric surgery at
the University of Pittsburgh, principal investigator in the study and
co-director of the Minimally Invasive Surgery Center at the University
of Pittsburgh Medical Center, the study suggests that early surgical
intervention is warranted to increase the likelihood of rendering
these patients euglycemic.

"Most patients in the study with type 2 diabetes who underwent bypass
surgery achieved excellent biochemical glycemic control and were able
to reap the clinical benefits of withdrawing from most, if not all,
anti-diabetes medications, including insulin," Dr. Schauer said.
"Younger diabetes patients with less severe disease stand to gain more
from the surgery by circumventing years of progressive, debilitating
disease."

The study included 1,160 patients who underwent Roux-en Y gastric
bypass surgery (LGBP) between 1997 and 2002 at the University of
Pittsburgh Medial Center. Of those patients, 240 had impaired fasting
glucose and type 2 diabetes. Follow-up was possible in 190. The mean
age at surgery was 48 years and 75 percent of the patients were
female. Mean body mass index was 50.

"Prior to surgery, the disease severity for these patients was quite
significant overall," said Dr. Schauer, "with 65 percent of them
requiring oral agents and 27 percent of them requiring insulin as
well."

Post surgery, patients had a mean excess weight loss of 60 percent and
a body mass index of 34 after 20 months. Fasting plasma glucose and
glycoslated hemoglobin concentrations returned to normal levels in 83
percent of patients, while 17 percent of patients markedly improved.
Following surgery, 80 percent of patients had a significant reduction
in the use of oral anti-diabetic agents and 79 percent had a reduction
in their use of insulin.

"The impressive effect of bypass surgery on morbidly obese patients
with type 2 diabetes raises an argument for lowering the threshold for
surgical intervention to moderate or mild obesity," Dr. Schauer said.
"Further investigation demonstrating risk versus benefit for patients
with moderate obesity is warranted."

The LGBP procedure involves constructing a small stomach pouch of
approximately 15 millimeters (about the size of a plastic medicine
cup), and bypassing a small segment of intestines by constructing a
Y-shaped limb of small bowel. Patients lose weight because there is a
decrease in caloric intake resulting from the reduced reservoir
capacity of the small stomach pouch.

Type 2 diabetes is the most common form of diabetes, in which the body
is unable to properly use the insulin that it produces. About 80
percent of people with type 2 diabetes are overweight.

Exactly a year ago there was another study from UCLA.  

Arch Surg. 2002 Oct;137(10):1109-17.  Related Articles, Links  

 
Effects of obesity surgery on non-insulin-dependent diabetes mellitus.

Greenway SE, Greenway FL 3rd, Klein S.

Department of Surgery, Harbor-University of California, Los Angeles
Medical Center, Torrance, CA 90509, USA.

CONTEXT: Most individuals who have non-insulin-dependent diabetes
mellitus are obese. The obese population has proved a frustrating
entity regarding weight loss and diabetes control. Results of medical
weight loss programs, medications, and behavior therapy have proved
disappointing. HYPOTHESIS: Bariatric surgery is the most effective
method of diabetes management and cure in the morbidly obese
population. Surgical procedures to cause malabsorption provide a more
dramatic effect on diabetes owing to the imparted bypass of the
hormonally active foregut. DATA SOURCES: Pertinent journal articles
spanning the last 40 years, as well as textbooks. CONCLUSIONS:
Bariatric surgical procedures have proven a much more successful
method of weight loss and diabetes control in the obese population
than conservative methods. These surgical procedures have proven safe
with reported mortality rates of 0% to 1.5%. Bariatric operations may
be divided based on the method of weight loss and effect on diabetes.
The first category is restrictive and includes vertical banded
gastroplasty and adjustable silicone gastric banding. These operations
improve diabetes by decreasing food intake and body weight with a
slowing of gastric emptying. The second category not only contains
restrictive components but also elements of malabsorption. This
category includes the Roux-en-Y gastric bypass and biliary-pancreatic
diversion, which bypass the foregut. Although all of the surgical
procedures for obesity offer improved weight loss and diabetes control
compared with conservative methods, the Roux-en-Y gastric bypass and
biliary-pancreatic diversion offer superior weight loss and resolution
of diabetes. The more dramatic effect seen in the surgical procedures
to cause malabsorption is likely secondary to the bypass of the
foregut resulting in increased weight loss and elevation of the
enteroglucagon level.

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PMID: 12361414 [PubMed - indexed for MEDLINE]