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By Melissa Tennen, HealthAtoZ writer
The progress of diabetes can be slowed or even stopped for people who had laparoscopic gastric bypass surgery (LGBP), one of the most common types of weight reduction surgery, according to a study from the University of Pittsburgh Medical Center (UPMC).
But does this mean a cure?
"It's about as close to a cure as you can get," says Philip R. Schauer, M.D., lead author of the study published in the Annals of Surgery and director of bariatric surgery at UPMC.
Although Schauer's study is not absolute proof that diabetes is helped with this surgery, the research is compelling. Even the National Institute of Diabetes and Digestive and Kidney Diseases refers to Schauer's research in its educational materials on weight reduction surgery.
Weight loss or internal change?
Exactly how the procedure helps resolve diabetes isn't clear. Is it the weight loss or the changes that the doctor makes with the digestive system? Many patients see their glucose levels decrease a few days after surgery.
"Weight loss can both reduce the risk of getting diabetes and treat diabetes itself. The greater the weight loss, the greater the effect," says Samuel Klein, M.D., professor of medicine and director of the Center for Human Nutrition at Washington University School of Medicine in St. Louis, and a spokesman for the North American Association for the Study of Obesity. He was not part of the study.
On the other hand, a significant number of people in the study started improving right after the surgery, long before the weight loss.
The study looked at 1,160 people who had the procedure between 1997 and 2002 at UPMC. Of that group, researchers were able to follow 190 people out of 240 who had diabetes before surgery. The average subject weighed more than 300 pounds at the time of surgery. In the five years after their surgery, on average people lost about 100 pounds, or 60 percent of excess body weight.
Even better, 83 percent did not have signs of type 2 diabetes. The people who had diabetes for the shortest period of less than five years and had the mildest forms of disease saw the greatest improvements.
Nearly one-third of patients stopped their diabetes medications before leaving the hospital. Schauer says improvements could be seen even before the person lost much weight.
Not everyone has the same benefits.
"It is possible that people with severe diabetes and pancreas failure will not see as much of a benefit as those with less advanced disease," Klein says.
That's why it's important to refer patients as early as possible, Schauer says.
"What's remarkable is that primary doctors, internists and diabetes doctors have not recognized this problem and have not recognized the value of surgery," Schauer says. "The doctor should be referring patients a lot sooner. Sometimes they hold onto to them for as long as 10 years."
It's a dollars and cents issue, Schauer points out.
"The fact is that it's very expensive to treat diabetes over a lifetime. Surgery is a one-time fee of $20,000," he says.
However, this surgery cannot guarantee diabetes won't return. Despite weight control, exercise and diets, many people with type 2 can't keep their blood sugars in a healthy range forever. One theory is that some people's insulin-producing cells just wear out from having to produce more and more insulin to deal with cells that have become insulin-resistant.
How diabetes works
Type 2 diabetes is a disorder of metabolism, or the way the body uses food for energy. Normally, food is broken down into glucose, a type of sugar that the body uses as fuel. Cells take in this sugar to create energy. A hormone made in the pancreas called insulin unlocks the "doors" of cells for the glucose to enter.
When we eat, the pancreas produces the right amount of insulin to move the glucose into cells. In type 2 diabetes, the pancreas produces too little insulin and the cells don't respond to the insulin. Glucose builds up in the blood and overflows into the urine.
Type 2 is the most common, affecting 90 to 95 percent of people with diabetes. This means the pancreas is producing insulin, but the body, for whatever reason, is not responding to insulin properly. After several years, the pancreas makes less insulin. Damage from diabetes builds for years and may not be noticed until the obvious symptoms have developed. Diabetes is a devastating disease, raising the risk of amputations, cardiovascular disease, blindness, nerve damage and kidney failure.
If anyone, regardless of gastric surgery, regains weight or cuts down on exercise, high blood sugar levels can return. If the person overeats, blood sugars probably would climb higher than someone who never had diabetes. Also, the decreased insulin production or increased insulin resistance that led to the initial diabetes diagnosis can intensify over the years and during periods of stress.
However, the purpose of laparoscopic gastric bypass surgery (LGBP) is to make the stomach smaller so the chances a patient will overeat are far less. The surgeon creates a small stomach pouch about the size of a shot glass that can hold 1 ounce of food. (The average stomach is about the size of a football.) People who go through such a surgery are more likely to take care of themselves by eating healthier and exercising. Right after surgery, patients lose weight quickly and continue losing for 18 to 24 months. Although most regain 5 percent to 10 percent of the weight they lost, many maintain a long-term weight loss of about 100 pounds.
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External Sources
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North American Association for the Study of Obesity
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American Diabetes Association
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University of Pittsburgh Medical Center
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This article was reviewed and updated June 2007.
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