Can Bariatric surgery cure type 2 diabetes?

Sounds too good to be true?  On March 26, 2012, the results of two studies were presented at the American College of Cardiology 2012 Scientific Session and published online in the New England Journal of Medicine. In both studies, bariatric surgery induced remission of diabetes symptoms as measured by reduced HbA1c measures from a mean in the larger study of 9.2 to 6.0.  HbA1c is a blood test that measures average blood glucose levels over 6-8 weeks and is conducted routinely every 3 months in doctor’s offices for those diagnosed with diabetes.

The larger study, conducted at Cleveland Clinic by Dr. Philip Schauer and colleagues enrolled 150 patients with uncontrolled type 2 diabetes and BMIs between 27 and 43 kg/m2. Obesity is defined as BMIs over 30. These patients were divided into three groups, two of which received surgery to reduce their stomach size. The third group was given intensive medical therapy for diabetes which included oral medications and/or insulin. After a year, only 12% of those treated with medicines alone were at a healthy A1c of 6 or below versus 42% and 37% of those receiving surgery. Use of medicines for high cholesterol and other heart risks also dropped among those in the surgery groups but rose in the group on medicines alone.

The second study was conducted in Rome, Italy by Dr. Geltrude Mingrone and colleagues and involved 60 severely obese patients (BMI >35) with advanced type 2 diabetes who were also randomly assigned to two types of bariatric surgery or intensive medical, nutrition and lifestyle therapy. After two years, 95% and 75% of the surgical groups had entered and maintained remission and were able to discontinue all diabetes medications. In contrast, none of the medical group had entered remission (HbA1c<6.5).

With about 80% of the 23 million American adults living with type 2 diabetes who are overweight or obese, these results are exciting. They also beg the question of why surgery would improve insulin control. Some remission was seen within days post surgery. One theory is that food makes the gut produce hormones to spur insulin, so trimming away part of it surgically may affect those hormones,

Caution is advised when recommending bariatric surgery, whether diabetic or not. These studies were small and long term results have not yet been seen. However, it is known that weight loss improves diabetes control and for obese patients who are not able to reduce weight by conventional methods, improved health could be achieved.

Will the future bring more research to confirm these results?  Let’s wait and see!