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Weight Loss Plays Key Role in Diabetes Improvement Following Bariatric Surgery

Published June 18, 2008 | Updated January 20, 2016

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Duke Health News919-660-1306

DURHAM, NC -- Stomach-reduction surgery is excellent
treatment for severe diabetes, but doctors at Duke University
Medical Center caution that it is not a magic bullet.

Their research, presented today at the American Society for
Metabolic and Bariatric Surgery, shows weight loss is a major
reason why severely obese type 2 diabetics experience disease
improvement or remission following surgery.

Earlier this year, weight loss surgery was heralded as a
cure for diabetes after studies reported dramatic cases of
post-surgical remission. Results were seen following both lap
band surgery and gastric bypass, but the most immediate
improvement was documented following gastric bypass. The theory
attributes diabetes improvement after gastric bypass to changes
in the way hormones are secreted from the gut and the pancreas
following gastric bypass which re-routes how food is sent from
the stomach to the small intestine.

Even before the latest findings were announced, a movement
was underfoot to alter the public's mindset about weight loss
surgery. Last year, the Bariatric Surgical Society changed its
name to the American Society for Metabolic and Bariatric
Surgery to reflect how "metabolic surgery" affects metabolic
conditions like diabetes and high cholesterol.

Yet, the Duke doctors say an important concept is being lost
in the hoopla surrounding the surgery's metabolic effects.
"Yes, there are physiologic changes related to the
restructuring of the gastrointestinal or GI tract that appear
to influence the rapid improvement in diabetes following
gastric bypass," says Eric DeMaria, MD, director of bariatric
surgery at Duke University Medical Center. "But our study shows
the patients who were able to get off medications completely
and go into remission were the ones who lost the most weight."
And, the more weight lost, the higher the chances of disease
improvement.

"We're a culture of quick-fix people," he adds. "Everybody
loves the idea that diabetes is gone the day after surgery. But
we know that an important mechanism in place when the operation
fails over the long term is poor behavior. High-fat junk food
and sweets, grazing or constant eating between meals, lack of
exercise, those are major contributors to failure, and failure
causes recurrent diabetes. If it were purely a metabolic
effect, one could argue that the metabolic effect should still
be present."

Type 2 diabetes is a metabolic disease that occurs when the
body can't properly use insulin or regulate blood sugars.
Nearly 20 million Americans have type 2 diabetes, and 90
percent of them are overweight or obese.

The Duke study followed 314 diabetic patients who underwent
gastric bypass surgery from January 2000 to October 2006. Of
the 314 patients, 71 were in the most severe group of diabetics
-- those who require insulin therapy because oral medications
were not sufficient to control the disease.

Gastric bypass overall had a highly successful effect on
diabetes. After 12 months, all the diabetic patients were able
to reduce the dose or number of their diabetes-related
medications. Nearly half (48%) of the 71 patients in the most
severe group had achieved remission of their diabetes, meaning
they ceased to need medications and a blood test found their
levels of a type of hemoglobin (HbAIc) to be within normal
range.

However, DeMaria stresses that losing weight during the
first three weeks to six months following surgery is critical
for patients who ultimately put their diabetes into remission.
"We may eventually consider adding weight-loss therapies during
this key time frame to enhance the already-effective treatment
of diabetes by surgery."

For now, to achieve long lasting results, he says, "we need
to tell patients to pay attention to their weight and to do
things that enhance weight loss. That can only be accomplished
by changing patient behavior and lifestyle. And that change can
only occur by emphasizing the proven concept that weight loss
and weight loss management are important components in the
treatment of diabetes."

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