A long-term study has found that weight-loss surgery is better than medication at controlling type 2 diabetes in obese people. Half of 60 people treated with either a Roux-en-Y or biliopancreatic diversion were free of diabetes 5 years after their surgery. In comparison, none of the 15 people treated with medications was free of diabetes.
Previous studies have found that weight-loss surgery, also called bariatric surgery, is more effective than treatment with medications of type 2 diabetes. However, few studies have had a long follow-up to see if the effect lasts.
The researchers randomly assigned 60 patients at one diabetes center in Italy to receive either medical treatment or one of the two types of weight-loss surgery in 2009. Fifty-three patients were available for the 5-year follow-up.
Eight patients in the gastric bypass group and seven in the biliopancreatic diversion group were diabetes free after 2 years, but were hyperglycemic after 5 years.
Eighty percent of patients who had surgery had their blood sugar under good long-term control, compared to about 25% of patients treated with drugs only.
All of the study groups had a reduction in cardiovascular risk. But the surgery-treated patients had a 50% lower risk of heart and blood vessel disease than those in the medication group. They also needed fewer drugs for treating high blood pressure or high cholesterol.
The improvements in blood sugar levels and cardiovascular risk did not correlate with how much weight the surgical patients lost.
"What really is causing the remission of diabetes after surgery remains mysterious," Dr. Francesco Rubino of Kings College London told Reuters Health. The intestines are known to produce many different hormones that are involved in regulating the body's metabolism. Surgically altering the stomach and small intestine may help restore normal metabolic control, he explained.
Weight loss surgery is not without risks, including infection and problems due to anesthesia. It is not a definitive cure for obesity, since some patients gain back some of the weight they lose.
