Giese is not sure how the surgery helps, but whatever the cause, liposuction "is changing insulin metabolism," she says. And that's why the government "is throwing money at [the research] and endocrinologists are going crazy for it," she says. "Not even a pill can improve insulin resistance like the liposuction does."
He may not be going crazy for it, but Mayo Clinic endocrinology consultant and American Diabetes Association past president Bruce Zimmerman, MD, does "think the premise is interesting." After reviewing the study's design for WebMD, he agrees that the idea, although a bit strange, may just be scientifically valid.
"The association between body fat and type 2 diabetes is strong," he tells WebMD, although several studies suggest that visceral fat -- that stored within the body cavity, rather than the under-the-skin type removed in liposuction -- is the crucial factor. "I wouldn't expect liposuction to have any effect on visceral fat, so it will be interesting to see if the [type of] fat that is removed makes any difference in insulin resistance and [disease] development."
Under-the-skin, or subcutaneous, fat has not been implicated in diabetes before, says Giese, because before large-volume liposuction was available, there was no way to remove large amounts of this type of fat and study the effects. The upcoming study "will tell us how subcutaneous fat acts in the development of insulin resistance, which will give us clues about the development, prevention and treatment of type 2 diabetes," she tells WebMD.
It "will be a more rigorous version of the pilot study," she says, involving five black and five white insulin-resistant women, all between 20 and 50 pounds overweight. The surgery, "a big operation that takes between four and five hours" and requires an overnight hospital stay, will be offered at a discount, says Giese, who is still searching for eligible participants.
Giese tells WebMD that large-volume liposuction will be especially helpful for those who, like her patients in the earlier study, "have gained 20 or 30 pounds at a particular, identifiable time -- during pregnancy, from stress, or after an injury -- and then have trouble losing it."
But according to Zimmerman, surgery "is not a reasonable approach" for preventing a disease that can almost always be avoided through basic lifestyle changes. "It's true that lifestyle modification is not easy for many people, but even if the study is markedly positive, we wouldn't extend that [to recommending] liposuction for all those who fit the characteristics of people in this study."
Even Giese advises liposuction as "a combined approach with diet and exercise." But if the new study is a success, "it might change the current standard for who should get liposuction. This is a new approach and it's nontraditional, but I think it can be incorporated into a weight-loss management program."