Weight loss surgery and Diabetes

[Dr Michael]

There has been some discussion about this topic on another thread,
A study has been released that was compares the results with intensive medical treatment.
150 patients in the active group.
It has shown how effective the By-pass and banding surgeries are after 12 months in blood sugar controp.

There is one element that confounds me and this was not in the paper--that some patients improve almost immediatly, even before they have lost the weight.

[MrPlum]

There has been some discussion about this topic on another thread,
A study has been released that was compares the results with intensive medical treatment.
150 patients in the active group.
It has shown how effective the By-pass and banding surgeries are after 12 months in blood sugar controp.

There is one element that confounds me and this was not in the paper--that some patients improve almost immediatly, even before they have lost the weight.

Can you provide a link to the study? Thanks.

[Dr Michael]

matic blood sugar control with gastric surgery
Radha Chitale

Gastric surgery controlled blood sugar better than intensive medical therapy among obese type 2 diabetics, according to the STAMPEDE trial, the results of which were presented recently at the recent 61st Annual Scientific Sessions of the American College of Cardiology meeting in Chicago, Illinois, US.

Patients who underwent Roux-en-Y gastric bypass surgery or sleeve gastrectomy achieved HbA1c control below 6 percent within a year in 42 percent (P=0.002) and 37 percent of cases (P=0.008), respectively, compared with 12 percent who received intensive medical therapy alone. [N Engl J Med 2012 Mar 26. Epub ahead of print]

“Despite improvements in pharmacotherapy, fewer than 50 percent of patients with moderate-to-severe type 2 diabetes actually achieve and maintain therapeutic thresholds, particularly for glycemic control,” said researchers from the Cleveland Clinic in Ohio, US, Veterans Affairs Boston Healthcare System and Brigham and Women’s Hospital in Boston, Massachusetts, US.

“Observational studies have suggested that bariatric or metabolic surgery can rapidly improve glycemic control...”

The trial randomized 150 obese patients (mean age 49 years, mean body mass index 36 kg/m2, mean HbA1c 9.2 percent) with uncontrolled type 2 diabetes to receive intensive medical therapy alone, medical therapy plus Roux-en-Y gastric bypass surgery or medical therapy plus sleeve gastrectomy.

Intense medical therapy followed the guidelines of the American Diabetes Association and included lifestyle counselling, weight management, and drug therapy.

Patients randomized to surgery experienced significantly more weight loss compared with those receiving medical therapy after 12 months (-29.5 kg gastric bypass, -25.1 kg sleeve gastrectomy, -5.4 kg medical therapy, P<0.001 for both) and lead author Dr. Philip Schauer, of the Cleveland Clinic, said this, more than anything else, was the likely driver for glycemic control.

Mean HbA1c was 6.4 percent in the gastric bypass group (P<0.001), 6.6 percent in the sleeve gastrectomy group (P=0.003) and 7.5 percent among patients receiving medical therapy.

Patients who underwent surgery also significantly reduced or halted use of glucose control and cardiovascular medications.

“Reductions in the use of diabetes medications occurred before achievement of maximal weight loss, which supports the concept that the mechanisms of improvement in diabetes involve physiologic effects in addition to weight loss...” the researchers said.

No deaths or life threatening complications occurred although four patients required a second surgery for complications.

In an accompanying comment, Dr. Paul Zimmet, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia, and Dr. K. George M. M. Alberti, Kings College Hospital, London, England, said surgery would not be the “universal panacea” for obese patients with type 2 diabetes and pointed out that the study duration was only 1 year and that surgery has inherent hazards. [N Engl J Med 2012 Mar 26. Epub ahead of print]

“There is also the problem of ‘remission’ versus ‘cure,’” they said. “Type 2 diabetes is often progressive, and worsening of glycemic control over time is likely in many patients. However, some years of improved glycemia may well result in less microvascular disease.”

Both the researchers and commenters called for further studies on the long-term clinical effects of gastric surgery.
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[Big Boy]

I probably mislead you (unintentionally) when I had my surgery. Although my blood sugars are now totally under control - I used to have 4 injections and 10 tablets per day; I do actually still take a little medication. I have been told that this will reduce to nothing as time goes by.

Basically, I still take Metformin 3 times per day, but to somebody whose control was very poor, I class this as cured. Weight loss is currently 57Kgs and dropping.

[Dr Michael]

what was your pre sugery wt.

How long after surgery were you able to discontinue Insulin injections and what was your wt at that time?

[migrant]

I probably mislead you (unintentionally) when I had my surgery. Although my blood sugars are now totally under control - I used to have 4 injections and 10 tablets per day; I do actually still take a little medication. I have been told that this will reduce to nothing as time goes by.

Basically, I still take Metformin 3 times per day, but to somebody whose control was very poor, I class this as cured. Weight loss is currently 57Kgs and dropping.

Wow great job!

[dtaai-maai]

Dr Michael - please check your messages on another matter.

[Big Boy]

what was your pre sugery wt.

How long after surgery were you able to discontinue Insulin injections and what was your wt at that time?

At my peak, I weighed in at 199.8Kgs As part of the Bristol trial into Exenatide, my weight reduced to 173.5Kgs pre-operation. This morning's weigh in was 141.2Kgs.

Immediately after the operation I stopped 2 daily injections of Exenatide, 2 daily injections of Insulin and 4 daily Gliclazide tablets.

To me, the operation was a miracle. I still have a bit of weight loss work to do, but I am very confident that the NHS have given me the tools to do it.

[PeteC]

What's the weight goal based upon your height BB? Pete

[Big Boy]

I don't have any goal at the moment - just to keep persevering until I feel right.

[traveller2]

Keep it up BB, you are doing a great job and the surgery must have completely altered your life.

[Big Boy]

Yes, it means that I have very little interest in eating or drinking these days. The part of the stomach they removed contains the bit that sends messages to the brain saying that you're hungry.

However, you don't get to 199.8Kgs by not already having had more than your share of food and drink, so it actually isn't a problem.

[Dr Michael]

Interestingly the op is beneficial for the patient but also the cost savings to the Health Care system means that it is a 'good deal' for insurance plans including govt ones.

[Big Boy]

Had I remained in the UK (without the operation), my medication would have been costing the NHS a few thousand every year. That cost doesn't take into account the cost of repairing anything else that could have gone wrong as a result of the diabetes. A definite win/win situation.

For anybody in 2 minds about the treatment - it was without any pain (apart from a little trapped wind in the chest), and I commend it to anybody who can benefit from it.

[MrPlum]

There is one element that confounds me and this was not in the paper--that some patients improve almost immediatly, even before they have lost the weight.

Not sure how long 'immediately' is but if you mean blood sugar readings, any detox or raw food clinic can tell you high blood sugar usually drops rapidly within 72 hours. High BP and cholesterol likewise.

This is where nutrients are taken in via fresh vegetable or citrus juices. I wonder if those particular patients may have, along with a reduced volume of food, also eaten more healthily? i.e. reduced sugar.

Similar results are achieved on a raw food diet. 'Raw for 30 days' is a film which addresses diabetes specifically. Worth tracking down and watching.