Acording to the American Diabetes Association, 25.8 million people in the United States have diabetes, which equals 8.3 percent of the population. Of the senior population of 65 and over, 10.9 million, or about 27 percent, have diabetes. With statistics such as these, two recent studies in the New England Journal of Medicine are bringing attention to surgeries that remove a portion of the stomach to control diabetes. These surgeries are the first of their kind, and while under some controversy, seem to have immediate positive results.
Diabetes – what is it?
Diabetes occurs when the body has a problem making or using insulin. The body needs insulin to move blood sugar, otherwise known as glucose, into the cells, which store the insulin and later use it for energy. Of the three types of diabetes, type 1, type 2 and gestational, type 2 diabetes is the most common. It is also known as “noninsulin-dependent diabetes” or “adult-onset diabetes.”
People with type 2 diabetes experience what is called insulin resistance where the cells in the body’s fat, liver and muscles don’t respond properly to insulin. The glucose does not get into the cells and therefore, cannot be stored for energy. The glucose then builds up in the blood resulting in hyperglycemia.
Most people who have type 2 diabetes are overweight when they are diagnosed because the body has a harder time using insulin correctly when it contains higher levels of fat. However, elderly people who are thin are at risk as well. Other risk factors include family history, low activity level and poor diet.
People with type 2 diabetes may not show symptoms for many years. The National Institute of Health lists the early symptoms of type 2 diabetes as:
- Bladder, kidney, skin or other infections that are more frequent or heal slowly
- Fatigue
- Hunger
- Increased thirst
- Increased urination
- Blurred vision
- Erectile dysfunction
- Pain or numbness in the feet or hands
- For seniors especially, hearing loss
A doctor can screen for and help a patient try to prevent the development of type 2 diabetes. However, if a person does find themself with type 2 diabetes, treatment with prescription drugs and advice to change to a healthier lifestyle and diet are usually the initial approach by physicians. Yet, many of the medicines prescribed to treat diabetes can actually cause weight gain and make the situation even worse for the patient.
How the surgery works
The gastrointestinal surgery for diabetics reduces the size of the stomach. Through a small incision in the abdomen, doctors can cut away part of the stomach and reconnect it to the small intestine. Gastric bypass is the most common of these surgeries. Initially used for patients with weight issues, gastric bypass surgery is now also an option for patients with diabetes.
The surgery appears to treat diabetes because food makes the stomach produce hormones that stimulate the production of insulin, and doctors believe that shrinking the size of the stomach may impact the rate at which the stomach produces hormones, thereby decreasing insulin production. The surgery costs approximately $15,000 to $25,000, and Medicare will often cover the costs for very obese people with diabetes.
The studies and their findings
The Cleveland Clinic’s Dr. Philip Schauer performed the first study about diabetes and gastrointestinal surgery. He studied 150 people who were given one of two kinds of surgery along with standard medicines and a third group who did not have surgery but were given only medicine. After a year of treatment, between 37 and 42 percent of the patients in the surgery groups had desirable blood-sugar levels, compared to 12 percent of the group given only medicine.
The second study was directed by Dr. Geltrude Mingrone at the Catholic University in Rome and Dr. Fancesco Rubino, New York Presbyterian Hospital/Weill Cornell Medical Center’s chief of diabetes surgery. Sixty patients received one of two types of surgery or solely medication. Two years after treatment, between 75 and95 percent of patients in the two surgery groups have maintained healthy blood-sugar levels with no additional medications. None of the people in the medicine-alone group were able to maintain healthy blood-sugar levels.
Rubino said that there were signs that the surgery itself – not just weight loss – helps reverse diabetes. Weight-loss surgery “has proven to be a very appropriate and excellent treatment for diabetes.”
The surgery results are considered dramatic. Generally, more patients reached normal blood-sugar levels through this type of surgery than by medicine alone. Some patients could stop taking their prescribed insulin within a week of the operation. The surgery also significantly improved cholesterol and other heart-risk indicators.
Even with all of the seemingly favorable outcomes to the surgery, doctors are not quick to claim that the surgery is a cure. They know that most patients in these studies were able to cease taking all diabetes drugs and the disease stayed in remission for at least two years, but there is still skepticism.
Not all experts agree
Doctors are still asking questions and expressing concerns about using gastric bypass surgery as treatment for diabetes. Mark Hyman, M.D. shares his thoughts in a Huffington Post article. “The researchers asked the wrong question. It should not have been, ’Does surgery work better than medication?’ but ’Does surgery work better than intensive lifestyle and diet change?’”
He is surprised that the researchers did not also investigate and determine if change of lifestyle and diet also had a profound effect on diabetes by including a treatment group that addressed this approach to combating the disease.
Hyman continues, “Lifestyle change and changes in diet work faster, better and more cheaply than any medication and are as effective as or more effective than gastric bypass without any side effects or long-term complications. These changes are not easy, but then neither is gastric bypass.”
Overall, doctors and researchers are hopeful that patients who chose to have the surgery will maintain healthy blood-sugar levels and not need to take medicine to control diabetes for the long-term. The results of the studies only show short-term gain at this point. Doctors would agree that a healthy lifestyle and diet are a less intrusive way to approach diabetes and reduce the chance of becoming diabetic in the first place.
Experts view the surgery as a viable option for patients with type 2 diabetes in the right situation; however, the surgery is not for everyone with type 2 diabetes. Consult with a physician to determine the best approach for you.