Is There Now a Cure for Diabetes?

Since November is Diabetes Awareness Month, we wanted to share some incredibly exciting news about a potential cure for Type 2 Diabetes.

OK. OK. Perhaps the previous sentence is a little dramatic, but studies published this year have presented some pretty compelling evidence that a surgical procedure that has been used since 1954 is now associated with dramatic levels of remission from Type 2 diabetes.

In fact, the Cleveland Clinic has called this procedure for the control of diabetes “The Top Medical Innovation for 2013”. And it’s not even 2013 yet!

The interesting thing is that this is not some obscure procedure. Moreover, it’s a procedure that many feel is of dubious value because they view it as elective surgery for people who have don’t have the willpower to stop eating. The procedure is known as gastric bypass or bariatric surgery.

Bariatric surgery is performed on morbidly obese people who have not been able to control their weight with other less invasive methods. The surgery consists of 2 parts – the first makes the stomach smaller by stapling off a large section where food would normally go. The section that remains, called a pouch, is about the size of a walnut and holds about an ounce of food. This naturally means that it takes much less food to make you feel full. The other part is the bypass, which involves having only a small part of the small intestine connected to the pouch. This means that the body absorbs fewer calories.

Bariatric surgery has been called the most effective treatment for obesity.

Since many people with diabetes suffer from obesity, doctors over the years found that, when their diabetic patients had bariatric surgery, their diabetes went into remission or, at least, their reliance on insulin was significantly reduced.

The studies published this year attempted to prove and to quantify this effect. The results are, to say the least, dramatic. The first study showed that 40% of patients who had this surgery were able to control their blood sugar more effectively. More significantly, an Italian study showed 75% of patients in full remission from their diabetes with one procedure and 95% remission rates for a more extreme procedure that bypassed more of the small intestine. And these aren’t just short-term results. A six-year study published in September showed a 62% diabetes remission rate in bariatric surgery patients after 6 years vs. 7 % in the non-surgery control group. Equally significant was a 2 % new diabetes incidence rate in the bariatric surgery group vs. 16% in the control group.

Since diabetes is linked to obesity and this procedure reduces obesity, these results, on one level, are impressive but not all that surprising.

The compelling findings are that the improvement in remission rates often started within a day of the procedure, well before the patients began to show weight loss. Moreover the best results were for people who were only borderline obese and/or using less diabetes medications.

Why this happens is not known for sure. But it is believed to be related to changes in the signals that the intestine sends the brain for hormone production. This is probably because, with the bypass, less of the intestine is actively sending the signals. Reinforcing this hypothesis is the fact that another obesity surgery (lap band) not involving the intestines did not produce any diabetes reduction results.

The implications for these findings are considerable. One of the problems with treating diabetes is that only half of the people on diabetes medications are able to control their disease. This can lead to kidney failure, stroke, blindness, amputations and heart attacks. People with diabetes die earlier. The health benefits of diabetes elimination or reduction with bariatric surgery are therefore enormous.

It should be noted that not everyone is excited. There are some that say that the risks of the surgical procedure outweigh the benefits, particularly if the patient regains the weight or doesn’t follow the required changes in lifestyle that this surgery requires.

Others point out that pure changes in diet and lifestyle can also produce these same diabetes remission and insulin control results without resorting to surgery.

Proponents of the surgery counter that the benefits to the patient and society of diabetes reduction more than justify the cost and risk of the surgery. They also point out that in some cases insulin is controlled without major lifestyle changes.

In any event, it’s clear that bariatric surgery should not be lumped into the class of elective surgical procedures like nose jobs and Botox treatments. Moreover it should not even be seen as surgery of the last resort for obese patients. Bariatric surgery should take its place in the arsenal that doctors are using against the disease that is the sixth leading cause of death in North America.

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