"We used to think bariatric surgery worked for purely mechanical reasons. That is, caloric restriction and decreased nutrient intake were responsible for the improvements in diabetes control," says Lee M. Kaplan, MD, PhD, director of the obesity research center at Massachusetts General Hospital in Boston.
New research shows that physiological changes associated with weight loss surgery, such as changes in gut hormones, may also help to drive diabetes into remission, he tells WebMD.
At a briefing that was sponsored by Ethicon Endo-Surgery, a maker of bariatric surgery products, Kaplan and other leading experts discussed how they are working to understand the mechanisms of weight loss surgical procedures at the tissue, cellular, molecular, and genetic levels.
The goal is to develop less invasive, less risky, and less costly approaches to fighting diabetes, says Philip Schauer, MD,professor of surgery at the Cleveland Clinic Lerner College of Medicine.
Extreme obesity, which affects nearly 24 million adults, or 5.7% of Americans, is associated with more than 30 medical conditions, including type 2 diabetes, coronary heart disease, stroke, hypertensionsleep apnea, joint disease, and cancer.
"Bariatric surgery works and works well -- for both obesity and diabetes," Schauer says.
In a recent study, 89% of people with type 2 diabetes who underwent gastric bypass surgery went into remission and 57% were still in remission after five years.
People who were at an early disease stage when they had the surgery were more likely to go into remission, Schauer says. "The first five or 10 years is when you have the best chance of recovery."
Although weight loss surgery is effective, there has been very little adoption of its use, Kaplan says.
Only one in 400 people with severe obesity in the U.S. undergoes bariatric surgery, he says.
The cost of treating diabetes is enormous, Schauer says. A person diagnosed at age 50 can expect to spend $172,000, the equivalent of seven gastric bypass procedures, on the condition.
The researchers don't know when new treatments aimed at the hormonal and genetic roots of diabetes will become available. But at least 12 studies are under way, Schauer says.