Does Gastric Sleeve Surgery "cure" diabetes?

[MINI-Me 196]

Now, I know there is no cure, per se, but I am interested in hearing from those of you who were diabetic pre-surgery. Have you noticed improvement? Are you seeing the need for medication eliminated or reduced? What about those who are dependent on insulin?

I am not diabetic, but I am meeting with a friend next week who is considering VSG. Besides being overweight, her main concern is managing her diabetes (pills, no insulin pump at this time). Please vote on the poll. And, any feedback would be appreciated.

[deletedsally 8]

Medical research supports the fact that WLS does cure diabetes for a high percentage of people. Doctors are using the word "cure."

http://www.msnbc.msn.com/id/22787261/#storyContinued

Does Weight Loss Surgery Cure Diabetes?

More than 30 studies say yes, according to the ASMBS. One recent study in the Journal of the American Medical Association (JAMA) found that 73 percent of people with diabetes who underwent gastric banding combined with conventional therapy achieved remission, which is defined as normal blood sugar levels and no need for diabetes medication. By contrast, just 13 percent of those people who received only conventional therapy went into remission. In this study, conventional therapy comprised lifestyle modificatons such as diet and increased physical activity, along with medication.

The people in the nonsurgical group lost just 1.7 percent of their body weight, compared with almost 21 percent among those who underwent gastric banding.

A landmark 2004 study in JAMA of more than 22,000 people who underwent bariatric surgery showed that type 2 diabetes was completely resolved in 76.8 percent of people, and it improved in 86 percent of people. The bariatric surgery procedures performed in this study included gastric banding, gastric bypass, gastroplasty, biliopancreatic diversion or duodenal switch, and others (such as jejunoileal bypass, a bypass of a section of the small intestine).

What's more, a study in the Annals of Surgery showed that 83 percent of 240 people who underwent gastric bypass were cured of their diabetes. Two studies in the New England Journal of Medicine found that bariatric surgery reduces the long-term mortality associated with obesity. In one of the two studies, the researchers found that long-term total mortality after gastric bypass surgery was significantly reduced, particularly deaths from diabetes.

Hutcher thinks the surgeries may benefit even people with diabetes who are not overweight or obese.

"We can do a diabetes-reversing operation without producing weight loss and without altering the stomach," he says.

Currently the National Institutes of Health guidelines recommend weight loss surgery for patients with a body mass index (BMI) over 40 and for people with diabetes or other obesity-related diseases whose BMI is over 35.

But many a bariatric surgeon including ASMBS president John W. Baker, MD, the medical director for Baptist Medical Center's Baptist Health Weight Loss Center in Little Rock, Arkansas, feel this cut-off is arbitrary and should be changed. "There is no clear rationale for it," says Baker, also the co- director of the Baptist Medical Center Bariatric Surgery Program.

This sentiment is echoed in a new consensus statement from the first International Diabetes Surgery Summit that will appear in the January 2010 edition of Annals of Surgery.

Setting the bar at 35 may do more harm than good for people with diabetes because it will allow their disease to progress to end-organ damage, Baker says. This may be more important than ever as the latest study shows that as many as 44 million Americans will have diabetes by 2034. That's up from 23 million today.

"We need trials that look at these surgeries in people with diabetes who have a BMI of 30 to 35," he says. If the studies are positive, bariatric surgeons can perform weight loss procedures on people with diabetes with lower BMI and ultimately save more lives.

"Surgery may resolve diabetes and when trials come out, it may give us impetus to lower the bar," he says.

Bariatric Surgery for Diabetes Saves Money

It's also much more cost-effective to treat diabetes with weight loss surgery than with conventional medical therapy, Hutcher says. "Non-surgical therapies can cost up to $33,000 per year for the entire life of the patient. Does the weight loss surgery cost that much? Heck no," he says. "The cost of weight loss surgery is usually less than the cost of one year's worth of diabetes treatment."

[Read more about bariatric surgery cost.]

How Does Bariatric Surgery Cure Diabetes?

Doctors know that bariatric surgery works at reversing diabetes; but what they don't know is how it works. "We have to do retrograde research to find out why this works, and in 20 years, this retrograde research and drug development may turn diabetes back into a nonsurgical disease," Hutcher says. "Finding out the why will turn diabetes back to a nonsurgical problem."

Some theories do exist, including the idea that shunting food directly to the lower intestine stimulates a substance called glucagon-like peptide 1, which can increase insulin production. Another theory suggests that hormones that prompt hunger may be dulled by rearranging the anatomy, so if they crave less sugar, people may be able to manage their blood sugar levels better.

Other questions remain regarding the role that weight loss surgery can play in treating, and potentially curing, diabetes. For starters, the ideal type of bariatric surgery for treating diabetes is not yet known. All of the studies have looked at different types of surgeries.

To help answer this question once and for all, The Cleveland Clinic Foundation is now recruiting for a five-year study of 150 men and women with type 2 diabetes aged 20 to 60 with BMIs between 30 and 40. The study will compare advanced medical therapy alone or advanced medical therapy combined with either Roux-en-Y gastric bypass or gastric sleeve surgery. Another question that remains is when the surgery should be performed ? that is, when diabetes is first diagnosed or down the road, when complications have already begun to arise.

Should Everyone with Diabetes Undergo Bariatric Surgery?

Not necessarily, says Hutcher. "This decision is up to the patient and the physician, but no obese patient with diabetes should be denied access to this surgery," he adds.

The bottom line is that bariatric surgery can play a big role in treating diabetes, according to Ren. "If you lose weight, your diabetes will go away, and when you regain the weight, the diabetes will come back," she says. "Diabetes is always lurking, and remission lasts as long as the weight loss lasts."

[MINI-Me 196]

Wow Katt ... Thank you so much!

[ANITALOU 2]

:001_unsure:Hey folks,

I was recently "interviewed" by a psych for pain management- I shared with him that I had lost some weight but still have about 80 lbs to go and that was struggling with all my complications- diabetic, hbp, closterol meds, arthrits meds, etc.... and he asked about bypass- had I considered that...I said no that I knew that I would end up in a nursing home here in East ky and that I did not think that they could or were prepared to keep someone with a bypass-6 meals a day, shakes, etc.. he told me about the sleve- hadn't heard of this..also told me that WLS virtually "eliminates" diabeties- (4 shots a day)...now I am seriously considering this. I weigh 234 down from 284- but it has taken 4 years and everytime I go on steriods I end up in the hospital and some wieght gain.... I am just so tired of shots, and meds.... I would love to hear from anyone who has had success in eliminating severe diabeties via WLS...I am going for a consult

ation next week, would love to have some success stores to encourage me...I am hesitant, but if I want to live beyond 10 more years I am thinking that I need to do something drastic...doing what I have been doing is not getting any results and my diabeties is "brickle" and I still lots on my bucket list! Living seems like the better option!

AnitaLou

Edited June 24, 2010 by ANITALOU

[MINI-Me 196]

:001_unsure:Hey folks,

I was recently "interviewed" by a psych for pain management- I shared with him that I had lost some weight but still have about 80 lbs to go and that was struggling with all my complications- diabetic, hbp, closterol meds, arthrits meds, etc.... and he asked about bypass- had I considered that...I said no that I knew that I would end up in a nursing home here in East ky and that I did not think that they could or were prepared to keep someone with a bypass-6 meals a day, shakes, etc.. he told me about the sleve- hadn't heard of this..also told me that WLS virtually "eliminates" diabeties- (4 shots a day)...now I am seriously considering this. I weigh 234 down from 284- but it has taken 4 years and everytime I go on steriods I end up in the hospital and some wieght gain.... I am just so tired of shots, and meds.... I would love to hear from anyone who has had success in eliminating severe diabeties via WLS...I am going for a consult

ation next week, would love to have some success stores to encourage me...I am hesitant, but if I want to live beyond 10 more years I am thinking that I need to do something drastic...doing what I have been doing is not getting any results and my diabeties is "brickle" and I still lots on my bucket list! Living seems like the better option!

AnitaLou

Welcome. The more I have researched this with my friend, the more success stories we have found. She is going to her consult with the surgeon next week & preliminary discussions is that VSG has a VERY good shot at eliminating her diabetes.

[Lori21769 14]

I am an insulin dependent diabetic. Pre-surgery I was taking 4 shots a day. 3 short-acting with meals, and 1 long-acting at bedtime. Since week two post-op, I have had NO short-acting insulin, and reduced my one shot at night by 75%. I expect soon to be off insulin completely.

[MINI-Me 196]

I am an insulin dependent diabetic. Pre-surgery I was taking 4 shots a day. 3 short-acting with meals, and 1 long-acting at bedtime. Since week two post-op, I have had NO short-acting insulin, and reduced my one shot at night by 75%. I expect soon to be off insulin completely.

That is absolutely AWESOME. Congratulations! :lol0:

[Lori21769 14]

I'm pretty pumped about it!

[dixienorco 2]

I am diabetic and a month out from surgery. I was on 850 mg. of Metformin twice a day and now I have not been taking any of the pills. My blood sugar has been below 120 to 105 which is decent. I still have to be careful of too many carbs or sugars but have been having some. As I lose more weight, I am hopeful the diabetes will go in remission.

[MINI-Me 196]

That is great news ... Congrats on your progress so far.

[tkurr 0]

I just had my sleeve done 7/12/10; I am a type II diabetic. I will let you know!

[pnw218 14]

My husband has not had VSG; was able to lose weight on his own. (brat!) However, he has lost over 40 pounds and his diabetes is now very under control. He has never taken insulin, just metformin. His numbers are so good that he may be able to reduce his meds as well.

He is also swimming about a mile three times a week - and he will turn 59 in August.

We have talked to several people with diabetes and weight loss in general seems to help alot.

Good luck to your friend!

[MINI-Me 196]

Congrats for your hubby and thanks for my friend. She is going through pre-op tests now and should have a date soon.

[ANITALOU 2]

Lori, Way to go....I am hoping that it will help me. I am so happy for you.. I too am a 4 shot a dayer...I don't mind the shots, I just hate knowing what it is doing to my body...I feel so bad all the time.. and I fluctuate wildly-- I have been as high as 500 and 3 to 4 hrs later been 54.....drives me crazy...and I have tried everything to try to "regulate" myself.. I just can't do it the way I work... If I could eat 6 meals a day I might could do it but with all the traveling I do I can't manage that. I am just so excited and encouraged..thanks for sharing....Best Wishes..Anita

[clk 3,519]

I'll wait to vote in the poll until I'm sure my sugars won't adjust upward once I hit mushies, but I'm a week out and haven't taken my metformin since the day before surgery.

I was on 2 pills daily, with additional pills as needed - so if my fasting sugar was above a certain number in the morning I'd take two pills with Breakfast, and the same goes for lunch. There were days when I took four pills, but even with pills I almost never saw my sugars (even fasting) drop below 130. That isn't terrible, but I'm only 29 and it didn't bode well for the future.

Since surgery they've dropped every day. The last several days they've been between 89 and 103. I have NEVER had a fasting blood sugar lower than 118 in the past. I'm amazed and can't wait to see if the numbers stay down. Even doing Medifast and Atkins in the past my numbers weren't this low, so I'm very hopeful.

~Cheri