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Weight Loss Surgery Puts Diabetes Into Remission

Bariatric Procedures Beat Out Medication at Controlling Blood Sugar
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Better Blood Sugar Control in Surgery Groups

At the start of the study, people had very high blood sugar, as measured by a test called hemoglobin A1c, or HbA1c. The average HA1c levels were 9.2% at the start of the study. An HbA1c level of 7% or lower is the traditional target for diabetes patients, but the study's goal was to reach a HbA1c level of 6% or less after one year.

Results showed that 42% of patients who underwent gastric bypass surgery achieved that goal, compared with 37% of patients who got the sleeve gastrectomy. Only 12% in the medication group reached that goal.

People who had surgery benefited in other ways, too. Their use of medications to lower blood pressure and cholesterol levels dropped, while use increased in people on intensive medical therapy. Not surprisingly, people getting surgery lost five times as much weight: about 55 to 64 pounds compared to 12 pounds in the medication group.

But surgery did have risks -- mainly bleeding, dehydration, and nausea. Fifteen of the 99 patients had side effects requiring hospitalization. No one died or had a life-threatening complication.

The study didn't compare costs, but surgery can run $20,000 to $30,000 and may not be covered by insurance, Schauer says. But medications can also add up. A person diagnosed at age 50 can expect to spend $172,000 on the condition -- that's equal to more than eight gastric bypass procedures, he says.

It's not year clear if lowering HbA1c levels to 6% or less translates to better heart health. "We would suspect it does, but it remains to be proven. More people have to be studied for longer periods of time," says Rick Nishimura, MD, a Mayo Clinic heart specialist and head of the ACC committee that chose which studies to highlight at the meeting.

People thinking about weight loss surgery should make sure to go to one of the approximate 500 hospitals that have been named "certified centers of excellence" by the American College of Surgeons or the American Society for Metabolic and Bariatric Surgery, Schauer says.

The study was funded in part by Ethicon Endo-Surgery Inc., a maker of bariatric surgery instruments. Schauer has consulted for the company.

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