The New York Times-20080124-Surgical Treatment for Diabetes- -Editorial-
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Surgical Treatment for Diabetes; [Editorial]
Evidence is accumulating that the best treatment for Type 2 diabetes related to obesity may well be the most drastic: stomach-shrinking surgery, perhaps accompanied by intestinal rearrangements. That such extreme remedies would even be considered is a measure of how intractable the intertwined epidemics of obesity and diabetes have become in the United States.
Diabetes of all types is a vicious disease that kills some 73,000 Americans each year, making it the fifth-leading cause of death in this country. It is characterized by an inability to produce or use insulin, with the result that blood glucose levels soar, damaging the kidneys, blood vessels in the eyes and nerves in the feet.
There is no cure, only the hope that it can be controlled by strict dieting, drugs and a lifetime of careful living. Unfortunately, many patients are unable to comply with the onerous regimen, pounds lost are ultimately regained and legions of patients suffer heart attacks, blindness, kidney failure or foot amputations.
Against that discouraging backdrop, a new study by Australian researchers, published in the Journal of the American Medical Association, seems to promise extraordinary results, albeit with many caveats about the preliminary nature of the findings in a relatively small group of patients who had mild cases of the disease.
The study involved 60 patients who were obese and had recently developed Type 2 diabetes, by far the most prevalent kind. Half were given conventional treatments, including diet, exercise and medicines. The rest got conventional treatment plus surgery in which a band is placed around the stomach to constrict its size and limit eating.
In almost three-quarters of those who had surgery, all signs of diabetes disappeared. Only 13 percent of those given conventional therapy had complete remissions. The difference was because of weight loss. Patients in the medically treated group lost only 1.7 percent of their weight, on average. Those in the surgically treated group lost 20.7 percent. There were no serious complications from the minimally invasive procedure.
Other studies have shown that gastric bypass surgery, a riskier operation in which the stomach is stapled and the intestinal tract rearranged, is even more effective, achieving remission in a matter of days or weeks, well before substantial weight loss has occurred. This is apparently because the operation causes metabolic changes that lower blood glucose levels beyond what weight loss alone can accomplish.
Some experts predict that surgery will become a common treatment for diabetes in coming years. Before that happens, it will be essential to see how patients fare over an extended period and get a better fix on which patients are most likely to benefit from costly surgeries that always bear some risk.
