NLM Director’s Comments Transcript
Weight Loss Surgery Controls Type 2 Diabetes?: 04/02/2012

Greetings from the National Library of Medicine and MedlinePlus.gov
Regards to all our listeners!
I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
Here is what's new this week in MedlinePlus.

Weight loss surgery controls type 2 diabetes for obese adults significantly better than widely used medical therapy, find two pioneering studies and an accompanying editorial recently published in the New England Journal of Medicine.
An Italian study of 60 obese adults with type 2 diabetes found persons in two surgical groups experienced a 75 and 95 percent remission of high blood sugar levels after two years compared to no remission among those who received recommended medical treatment (that included regular monitoring and medications to control blood sugar levels). One group of study participants received gastric bypass surgery while the other group received a biliopancreatic diversion operation.
Gastric bypass sends food from a small pouch in the stomach directly to the small intestine. Biliopancreatic diversion removes a large part of the stomach and also bypasses a part of the small intestine.
While the biliopancreatic diversion resulted in a higher remission of blood sugar levels, the latter operation was associated with more harmful nutritional side effects. The study’s 11 researchers reported patients in both surgical groups eventually were able to stop taking diabetes medications. The Italian study was done at the Catholic University in Rome.
Similarly, a U.S. study of 150 obese adults with type 2 diabetes found persons in two surgical groups experienced a 42 and 37 percent remission of high blood sugar compared to a 12 remission from an intensive, non-surgical clinical intervention. The study’s 10 authors reported the use of drugs to lower glucose, lipid, and blood pressure levels also comparatively decreased significantly within the surgical groups. An editorial that accompanied the two studies explained one of the U.S. study’s surgical procedures was different — and the degree of type 2 diabetes patient monitoring and intervention in the U.S. study (which was done at the Cleveland Clinic) was more rigorous than in Italy.
The surgical procedures used in Cleveland included a gastric bypass and a sleeve gastrectomy. Both surgeries reduce the stomach’s size but use a somewhat different procedure to reroute digestion within the small intestine. In the Cleveland study, the gastric bypass patients experienced the highest blood sugar remission rate, or improvement in type 2 diabetes.
Investigators in the Italian and U.S. studies explained they became intrigued by the potential of weight loss surgery to control type 2 diabetes after prior case studies of obese persons who received weight loss surgeries reported an unexpected diabetes remission.
The editorial accompanying the two studies reported they are the first to compare and document the impact of weight loss surgery versus traditional care on obese adults with type 2 diabetes. The editorial noted the overall findings will have a significant impact on type 2 diabetes treatment and suggests weight loss surgery (and we quote) ‘might well be considered earlier in the treatment of obese patients with Type 2 diabetes’ (end of quote).
Nevertheless, the editorial noted the number of patients in the Italian and U.S. studies were too small to generalize to larger patient populations. The editorial added the uncertain duration of post-surgical blood sugar remission after a year or two suggests weight loss surgery yields diabetes remission rather than a cure. In addition, the editorial suggests further research should assess which weight loss surgical procedure seems to be the safest and most effective in type 2 diabetes intervention.
The American Society of Metabolic and Bariatric Surgery reports about there are about 200,000 weight loss operations annually in the U.S., which cost from $11,500 to $26,000.
In an article about the current research, the New York Times reports about 20 million Americans have diabetes. MedlinePlus.gov’s diabetes type 2 health topic page reports about 90 percent of diabetes cases are Type 2, which is more associated with obesity among adults. Diabetes can lead to serious problems with the heart, eyes, kidneys, nerves, gum, and teeth.
Some differences in weight loss surgical procedures are described in a website (provided by the National Institute on Diabetes and Digestive and Kidney Diseases) in the ‘overviews’ section of MedlinePlus.gov’s weight loss surgery health topic page. Information about gastric bypass surgery is available from two websites also within the ‘overviews’ section. A video of the sleeve gastrectomy weight loss surgery is available in the ‘videos’ section.
MedlinePlus.gov’s weight loss surgery and diabetes type 2 health topic pages provide research summaries within the ‘research’ section. Similar links to the latest pertinent journal research articles are available in the ‘journal articles’ section within MedlinePlus.gov’s weight loss surgery and type 2 diabetes health topic pages. Links to related clinical trials that may occur in your area are available in the ‘clinical trials’ section.
From the weight loss surgery and diabetes type 2 health topic pages, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.
To find MedlinePlus.gov’s weight loss surgery health topic page, type ‘weight loss surgery’ in the search box on MedlinePlus.gov’s home page, then, click on ‘weight loss surgery (National Library of Medicine).’
To find MedlinePlus.gov’s diabetes type 2 health topic page, please type ‘Type 2 diabetes’ in the search box on MedlinePlus.gov’s home page, that’s ‘D…I…A…B…E…T…E...S’ then, click on ‘diabetes type 2 (National Library of Medicine).’
While the Italian and U.S. studies received recent attention from the news media (because type 2 diabetes remission is so promising for patients and caregivers), we emphasize the extent weight loss surgery helps obese diabetes patients (as well as others with type 2 diabetes) remains undetermined. Let’s hope this joins an array of other, future, available clinical options to counter Type 2 diabetes.
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