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Weight-loss surgery reduces diabetes

A large international study has found that weight-loss surgery can eliminate the symptoms of type-2 diabetes in nearly eight out of 10 patients

A large international study has found that weight-loss surgery can eliminate the symptoms of type 2 diabetes in nearly eight out of 10 patients.

The research, published in The American Journal of Medicine (AJM), reviewed the effect of bariatric (weight-loss) surgery on weight and type 2 diabetes. Several studies, covering a total of 4,070 diabetic patients, found bariatric surgery to be greatly effective for both reducing weight and improving diabetes, both in the short and long term.

The research was carried out by Dr Henry Buchwald and colleagues from the University of Minnesota and other US institutions, funded by Ethicon Endo-Surgery Inc, a Johnson & Johnson company.

The researchers searched medical databases for all studies published in English from January 1 1990 to April 30 2006 on banding, gastroplasty, gastric bypass or biliopancreatic diversion/duodenal switch, and assessed weight loss and type 2 diabetes outcomes. The various findings were combined using meta-analysis.

They pooled outcomes reflecting improvement in type 2 diabetes within two years of surgery, and longer-term improvement after two years.

A total of 621 studies met their inclusion criteria, covering 135,246 patients. Of these, studies that had reported on the resolution of clinical and laboratory manifestations of type 2 diabetes, involved 3,188 patients. In 19 studies, weight loss and diabetes resolution were reported separately for 4,070 diabetic people. Only 30 studies were randomised controlled trials and, of these, 10 were rated as high quality.

The average age for people receiving bariatric surgery was 40.2 years. Women represented 80 per cent of the total and the average BMI was 47.9. Overall weight loss was 38.5kg, or 55.9 per cent loss of excess body weight.

There was complete diabetes resolution in 78.1 per cent of patients, with improvement or resolution in 86.6 per cent of patients. Biliopancreatic diversion/duodenal switch gave the greatest improvement in weight reduction and diabetes resolution (95.1 per cent resolved). This was followed by gastric bypass (80.3 per cent). Banding procedures gave the lowest result (56.7 per cent resolved).

There was a significant post-operative reduction in insulin levels, HbA1c and fasting glucose values.

The reviewers concluded that the clinical and laboratory manifestations of type 2 diabetes are resolved or improved in the majority of patients who undergo bariatric surgery. Procedures associated with the greatest loss of excess body weight gave the most pronounced improvement.

Bariatric surgery may be expected to lead to some improvement in diabetes because it causes weight loss, but this does not mean that weight-loss surgery is the solution to diabetes. Such surgery is only performed as a last resort in morbidly obese people.

The study, Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-analysis, was published in the March 2009 edition of AJM, the results of which were presented at a Paris conference at the weekend.

2nd September 2009

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