Saturday, March 13, 2010

Study to examine Gastric Bypass for treatment of diabetes in non-obese patients

Gastric bypass surgery to treat diabetes in non-obese patients?

New York, NY
Patients with a body mass index below 35 generally do not qualify for weight loss surgery. But, researchers at Weill Cornell Medical Center in New York City are embarking on a new study to determine whether gastric bypass surgery can be an effective treatment for type 2 diabetes in people who are overweight but not obese.

The study aims to explore the correlation of diabetes and clinical obesity. Lead researcher Dr. Francesco Rubino notes that many people with a lower BMI can develop diabetes, and likewise, that someone who is severely obese could be diabetes free.

“For this reason alone, we need to start questioning whether BMI should be the only clinically appropriate way to decide who gets diabetes-targeted surgery,” Dr. Rubino said in a recent press statement. Diabetes affects more than 200 million people worldwide, and several studies have demonstrated that gastric bypass surgery can lead to spontaneous improvement or even resolution of the disease.

Dr. Rubino generally performs the standard Roux-en-Y bypass procedure in patients with a BMI over 35. Now, the potential benefits of the procedure are being extended to 50 non-obese patients as part of the current study.
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Tuesday, November 24, 2009

Doctors embrace bariatric surgery as effective treatment for diabetes

Los Angeles, CA
Fifty international scientific and medical experts have issued a "consensus statement" declaring that bariatric surgery should be considered a treatment option for patients with Type 2 diabetes, even if they are not extremely obese.

The new guidelines, published today online in the Annals of Surgery, urge surgeons performing bariatric surgery and healthcare insurers reimbursing for such treatment to relax criteria, adopted in 1991, that have restricted such surgery to patients with a body-mass index of 35 or more.

Reviewing more than a decade's worth of studies on weight-loss surgery and diabetes, clinicians and researchers backing the document have concluded that the improved metabolic function that is typical in diabetic patients who undergo bariatric surgery is not merely an incidental effect of weight loss. "Surgery is a specific treatment for diabetes...the effect on diabetes is a direct consequence of the new anatomy created by surgery," said lead author Dr. Francesco Rubino, director of the gastrointestinal metabolic surgery program at New York-Presbyterian Hospital/Weill Cornell Medical College.

The implications, added Rubino in an interview, "are enormous." For starters, that finding should drive a broadening of the patient population offered the option of gastric bypass surgery or less invasive procedures that reduce the capacity of the gastrointestinal tract. Rubino said that patients with Type 2 diabetes that is poorly managed by diet, exercise and medicine should now routinely be assessed as surgery candidates.

Some of those will likely be far less overweight than the bulk of patients who have had the surgery for weight loss. Rubino cited the example of diabetic patients of Asian descent, who rarely reach a BMI of 35 but who might benefit from bariatric surgery.

For the more than 20 million Americans -- and counting -- thought to have Type 2 diabetes, bariatric surgery may offer more than just another treatment option. Research shows that for many patients, diabetes abates dramatically and permanently with surgery. That, said Rubino, makes the possibility of a "cure"--a prospect not discussed until very recently--real for many patients who have been told that "living with diabetes" is the best they can do.

Beyond that, said Rubino, clinicians caring for these patients will need to optimize their pre- and post-operative care to serve a new objective: that of improving metabolic function. Currently, many bariatric surgery patients continue on diabetes medicines after their operation when that might not be optimal or even necessary.

Finally, the consensus finding should guide the search for drugs that can better treat Type 2 diabetes. Those should focus on how metabolic function is changed by an alteration of the gut's anatomy, and whether drugs could be developed or adapted to work in the same way, Rubino said.
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Sunday, November 1, 2009

Gastric bypass and diabetes: CNN Health Q&A

Q: Does roux-en-Y gastric bypass cure diabetes?

Expert Answer: (by Dr. Melina Jampolis)
Hi, Rick. I'm not a surgeon, so to answer your question more thoroughly, I consulted with a very well-respected bariatric surgeon in San Francisco, John Rabkin, M.D. He explained that the roux-en-Y gastric bypass (RGB) improves type 2 diabetes via at least three different mechanisms:

1. The surgery decreases caloric intake immediately after the procedure because food intake is restricted by the small volume of the created stomach pouch, which holds only 1 ounce. The decrease in food intake, particularly refined carbohydrates, which are not well-tolerated after this procedure, can help stabilize blood sugar levels and immediately improves control of diabetes.

2. The significant amount of weight loss that results from the surgery improves insulin resistance over time.

3. There are changes in hormones and caloric processing because the food ingested bypasses the segment of the small intestine closest to where it attaches to the stomach (the duodenum and proximal jejunum), but not quite as much as you mentioned (not one-third of the small intestine). Because of the anatomical changes resulting from the surgery, it appears that these hormonal changes are greater than would be seen with weight loss via diet and exercise, but no research has yet to compare the two directly and evaluate hormonal changes.

The overall outcome is complete resolution of type 2 diabetes in greater than 70 percent of patients with diabetes before the procedure.

Unfortunately, as many RGB patients regain weight over time, the durability of the cure isn't as high as with a newer procedure called the duodenal switch.

In this procedure, there is a much larger pouch created (4 to 5 ounces), and the complete stomach anatomy is preserved, which helps preserve more normal stomach function. In this procedure, the rearrangement of the intestines leads not only to some restriction of food, but also causes your body to absorb significantly fewer calories, which has a more lasting effect.

Rabkin, a leader in this procedure, reports that he has had a 96 percent cure of type 2 diabetes at one year after surgery, which has persisted for five and 10 years post -op and seems to be similarly durable out past 15 years post-op.

Hope this helps. I strongly recommend spending a considerable amount of time with your surgeon if you are considering either of these procedures, as both have important lifestyle-related issues that should be discussed to determine the best procedure for you for the long term.

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Tuesday, October 27, 2009

Is gastric bypass surgery a diabetes fix?

Los Angeles, CA

Within days of various weight-loss surgeries, blood sugar levels become easier to manage -- or are normal.
The discovery came about by accident more than a decade ago: Weight-loss surgery often led to dramatic improvements in the control of Type 2 diabetes, often before patients had even left the hospital.

Today, evidence of the connection is so solid that some doctors say surgery should be considered as a treatment for diabetes, regardless of a person's weight or desire to lose weight.

"We thought diabetes was an incurable, progressive disease," says Dr. Walter J. Pories, a professor of surgery at East Carolina University and a leading researcher on weight-loss surgery. "It . . . is a major cause of amputations, renal failure and blindness. This operation takes about an hour, and two days in the hospital, and these people go off their diabetes medication. It's unbelievable."

As many as 86% of obese people with Type 2 diabetes find their diabetes is gone or much easier to control within days of having weight-loss surgery, according to a meta-analysis of 19 studies published earlier this year in the American Journal of Medicine (78% of patients with a remission of diabetes and 86.6% with remission or improvement). But experts still aren't sure why obesity surgery helps resolve Type 2 diabetes or how long the effect might last. And they disagree on how big a role surgery should take in treating the illness.

"We are going from seeing the results to understanding why it happens," said Dr. Santiago Horgan, director of the Center for the Treatment of Obesity at UC San Diego.

This much is clear: Patients who have weight-loss surgery begin to lose weight rapidly, which by itself improves Type 2 diabetes, allowing diabetics to more easily control their blood glucose levels. But something else appears to be occurring as well.

There is strong evidence that surgery -- especially gastric bypass surgery, which makes the stomach smaller and allows food to bypass part of the small intestine -- causes chemical changes in the intestine, says Dr. Jonathan Q. Purnell, director of the Bionutrition Unit at Oregon Health & Science University. The small intestine has been thought of simply as the place where digestion occurs.

But researchers now suspect it has other functions related to metabolism. Surgery somehow alters the secretion of hormones in the gut that play a role in appetite and help process sugar normally.

Multiple studies in humans and animals indicate that surgery triggers reductions in ghrelin, the hormone that stimulates hunger, and elevates levels of peptide YY and glucagon-like peptide-1, both of which act as appetite suppressants. Another theory is that surgery might alter the expression of genes that regulate glucose and fatty-acid metabolism.

"There are these known components that improve glucose metabolism," Purnell says. "But there are very likely other things happening as well."

Which procedure?

The effect on diabetes can depend on the type of weight-loss surgery that is performed, says Pories, past president of the American Society for Metabolic and Bariatric Surgery. The highest rates of diabetes remission are seen in people who have gastric bypass -- about 83%.

But diabetes also tends to resolve or improve in 50% to 80% of people who have lap-band surgery, in which a band is placed around the top of the stomach to make it smaller, he says. And there is some evidence that the effect occurs a newer type of weight-loss surgery called gastric sleeve, in which a portion of the stomach is removed so that it takes the shape of a tube or sleeve.

Evidence suggests the effect on diabetes can last for an extended period or even indefinitely, particularly if people don't regain a lot of weight.

"There is durability, but we also know that some people do get the disease back again," Purnell says. "Weight rebound is probably one factor. We also know that diabetes is a progressive disease. It may depend on how long you've been diagnosed with diabetes. If it's early on, I think the durability may be better."

It's not clear yet why people have different responses.

"There is some evidence that African Americans don't respond as well as Caucasians, and men don't respond as well as women," Pories says.

Despite the unknowns, the evidence that a majority of people experience long-term improvement in blood glucose control suggests the surgery could eventually play a greater role in the treatment of obese people with Type 2 diabetes. The majority of American adults with Type 2 diabetes are overweight.

Traditional medical guidelines, which insurers follow, state that weight-loss surgery should be restricted to patients with a body mass index of 35 or greater who have related health problems. But some diabetes and nutrition experts think those recommendations don't go far enough. Several studies are underway, or will soon begin, to examine the benefits of surgery in people with Type 2 diabetes and a BMI of less than 35.

"We may have a cure for diabetes," Santiago says. "So we need to ask how medical therapies and surgery can help each other in the treatment of diabetes."

Studies from several other countries show that surgery also results in remission of diabetes for people who are not morbidly obese. There is even discussion, particularly in other countries, of performing weight-loss surgery for people with Type 2 diabetes who are not overweight.

Not without risks

In the United States, weight-loss surgery is still largely viewed as a cosmetic procedure and obesity as a lifestyle issue, not a chronic disease. Moreover, weight-loss surgery carries risks. The death rate is about one per 200 operations and severe complications can occur, including blood clots, infections related to surgery, and the need for corrective surgery due to leaks at the staple lines.

Other complications include vitamin and mineral deficiencies, dehydration, gallstones, kidney stones, hernia and low blood sugar.

However, a risk-benefit analysis published in April in the Journal of the American Medical Assn. by Purnell and a colleague suggests that if the number of gastric bypass operations performed on diabetic patients increased to 1 million per year, as many as 14,310 diabetes-related deaths might be prevented over five years.

Surgery also leads to other health benefits besides weight loss and better control of diabetes. Patients often see improvements in blood pressure, cholesterol, gastroesophageal reflux disease and sleep apnea.

"Doctors say, 'If I can lower glucose by medications, why send patients to surgery?' " Purnell says. "Surgery, however, allows people to have meaningful and sustained weight loss and their diabetes is better. There are risks involved with surgery, obviously, but it makes sense, to me, to do surgery."

The discovery of the gut hormones that play a role in appetite and insulin regulation may also lead to new medications for Type 2 diabetes, Pories says.

"You can't operate on 31 million Americans," he says. "But if we understood this mechanism and what are the molecules secreted by the intestines that cause diabetes, then we can cure it with a pill. I would not be surprised if, in the next five years, we have new medications."

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Wednesday, February 18, 2009

Medicare Announces Final Coverage Policy for Bariatric Surgery as a Diabetes Treatment


Washington, D.C.
The Centers for Medicare & Medicaid Services (CMS) announced today a clarification in its policy for Medicare coverage of bariatric surgery as a treatment for certain beneficiaries with type 2 (or non-insulin-dependent) diabetes.

The decision specifies type 2 diabetes as one of the co-morbidities CMS would consider in determining whether bariatric surgery would be covered for a Medicare beneficiary who is morbidly obese, as long as the surgery is furnished at a CMS-approved facility. An individual with a body-mass index (BMI) of at least 35 is considered morbidly obese. Normal body-mass index is considered to be between 18.5 and 25.

“Medicare beneficiaries who are morbidly obese may face tremendous health complications,” said CMS Acting Administrator Charlene Frizzera. “Today’s coverage decision assures that beneficiaries who are morbidly obese can access safe, effective weight loss options to help prevent these complications.”

As part of today’s decision, CMS announced bariatric surgery will not be covered by Medicare when it is used to treat type 2 diabetes in a beneficiary with a BMI below 35. While recent medical reports claimed that bariatric surgery may be helpful for these patients, CMS did not find convincing medical evidence that bariatric surgery improved health outcomes for these non-morbidly obese individuals.

“Limiting coverage of bariatric surgery in type 2 diabetic patients who are not considered clinically obese is part of Medicare’s ongoing commitment to ensure access to the most effective treatment alternatives with good evidence of benefit, while limiting coverage where the current evidence suggests the risks outweigh the benefits,” said Barry Straube, M.D., CMS Chief Medical Officer and Director of the agency’s Office of Clinical Standards & Quality.

In 2006, CMS expanded coverage of bariatric surgery for Medicare beneficiaries who received surgery in high-volume centers from highly qualified surgeons (as certified by the American College of Surgeons or the American Society for Bariatric Surgery, and as reported on the Medicare Coverage Web site).

Under the 2006 decision, to be considered for coverage, Medicare beneficiaries were required to have a BMI of 35 or higher, and to have exhibited a serious health condition in addition to morbid obesity, such as hypertension, coronary artery disease, or osteoarthritis.

In that same decision, CMS covered four types of bariatric surgery procedures: gastric bypass, open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch. No other bariatric surgery procedure is currently covered.

Today’s decision memorandum is available on CMS’ Coverage Web site at:
http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=219

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Sunday, January 4, 2009

Gastric bypass surgery resolves diabetes in teens


Los Angelos, CA
Teenagers who undergo gastric bypass surgery are often immediately relieved of Type 2 diabetes, according to research published today in the journal Pediatrics.

Studies on adults with Type 2 diabetes show that gastric bypass can result in disease remission or better disease control. However, this study is the first to explore the effects of the surgery in children. The study examined adolescents with Type 2 diabetes, which is usually related to obesity and is being diagnosed with alarming frequency in American children and teenagers.

Dr. Thomas Inge, director of the Cincinnati Children's Surgical Weight Loss Program for Teens, studied 11 extremely obese teens with Type 2 diabetes who had gastric bypass surgery and 67 obese teens who were receiving medical management for Type 2 diabetes. Among the 11 teens who underwent surgery, all but one had a remission in diabetes. The response was so rapid, the patients often discontinued medication for diabetes control before leaving the hospital after surgery. These teens lost an average of 34% of their body weight one year after surgery. In contrast, the teens who were medically managed did not have any weight change after one year and were all still taking medication for diabetes. The adolescents who had surgery also had improvements in blood pressure, cholesterol and triglyceride levels.

"The results have been quite dramatic and to our knowledge, there are no other anti-diabetic therapies that result in more effective and long-term control than that seen with bariatric surgery," Inge said in a news release.

Inge and his co-authors noted that future studies will be needed to track the long-term health of teenagers who participated in the study. Cincinnati Children's Hospital is home to a study funded by the National Institutes of Health that will collect and report outcomes on 200 teens undergoing weight-loss surgery nationwide.

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Saturday, December 20, 2008

Weight loss surgery may cure form of diabetes


Tampa, FL
Gastric bypass surgery helps thousands lose weight, but it may also be a cure for Type Two Diabetes. The drastic weight-loss approach means some diabetics never need insulin again.

Cheryl Bishop's weight has been a life-long battle. “I was always the chunky kid and it just got progressively worse and worse and worse until it was out of control," she said. At 44, she weighed 350 pounds and struggled with Type-Two Diabetes. “It was horrible. It got to the point where I knew I had to have the surgery or I wasn't going to live."

Cheryl had bariatric surgery. Surgeons sectioned off a small pouch of her stomach and attached it to her intestine. The goal is weight loss, but surgeons like Doctor Michel Murr, of Tampa General Hospital, discovered another dramatic effect: Cheryl's Type Two Diabetes disappeared. He says, “There's a function of the stomach that we don't understand very well, but as soon as we divert food away from it, the diabetics control their blood sugar much, much easier."

Studies show up to 90-percent of diabetics go into remission after bariatric surgery. Cheryl says, “I went from taking 100 units of insulin three times a day with blood sugar still 200, 300 plus. Within a week after surgery, probably none."

Right now, bariatric surgery is only for the extremely obese, but doctors believe it could be the key to reversing Type Two Diabetes, regardless of a person's weight.

Doctor Murr says, “We may be looking into this as one of the treatments for diabetics."

One-hundred-thirty pounds lighter, Cheryl's enjoying her new life, one that's healthier and diabetes free. She says, "It's gone. The diabetes is gone."

Almost 18 million Americans are diagnosed with Type Two Diabetes and roughly six million others have it, but don't know. Researchers in Brazil are studying whether bariatric surgery is safe and effective for type two diabetics who are not severely overweight.

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Tuesday, September 30, 2008

Could gastric bypass surgery cure diabetes?


Raleigh, NC
Gastric bypass and other surgeries have become a popular way for the obese to lose weight. The procedure has also proven effective at curing diabetes.

Mary Stanford weighed 300 pounds four years ago and was a Type 2 diabetic. Gastric bypass surgery helped her lose 140 pounds, and her diabetes disappeared almost immediately.

“(It was) definitely a relief. Your sugars are normal, you don't have to worry about testing every day (and) you don't have to worry about remembering to take your medication,” she said.

Some doctors are considering gastric bypass for a larger number of diabetics.

“We now have sufficient evidence that gastric bypass can improve diabetes dramatically,” said Dr. Francesco Rubino with the Weill Cornell Medical Center in New York.

There is an obesity threshold. Someone who is 5 feet 8 inches tall has to be at least 230 pounds to get the surgery. Rubino said he planned to begin a new study, performing the surgery on patients about 30 pounds lighter.

“We're going to compare surgery [with] conventional medical treatment to understand whether surgery might be preferable in this subset of patients,” he said.

Researchers say it's not just the weight loss that rids the body of diabetes. The surgery might also spark hormonal changes in the body.

“A large number of people with diabetes will see their diabetes drop off within days to a few weeks after the bypass, long before they've lost much weight,” said Dr. David Crumpler, an endocrinologist.

Experts say they believe it's possible that the surgery could even help diabetics who are just overweight and not obese.

“We have to be very cautious and do more studies before we offer surgery to everybody,” Rubino said.

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Thursday, September 25, 2008

Weight loss more difficult for diabetics after gastric byass surgery, new study shows


Winter Park, FL
Diabetics and people with larger stomachs may have more difficulty losing weight after gastric bypass surgery, according to a new study.

The surgery involves doctors creating a smaller stomach pouch that restricts food intake and bypasses large sections of the digestive system. Although it’s an effective way for thousands of obese people to lose weight, approximately five to 15 percent of patients do not lose weight successfully.

In the study, 12 percent of patients did not lose the expected amount of weight a year after the surgery. Diabetes and having a larger size stomach pouch after surgery were independently associated with poor weight loss, researchers said.

The study’s authors said diabetics might take insulin or other drugs that stimulate the production of fat and cholesterol. They concluded that changes in the use of diabetes medications may reduce the risk of poor weight loss after gastric bypass surgery.

During gastric bypass, surgeons estimate the stomach pouch size using anatomical landmarks rather than using a sizing balloon.

“As the use of gastric bypass continues to grow, we believe it is critical to stress the importance of and to teach the creation of the small gastric pouch and to better standardize the technique used for pouch creation,” the authors wrote.

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Saturday, September 6, 2008

Gastric bypass surgery can reverse metabolic syndrome


Rochester, MN
Metabolic syndrome, a cluster of conditions that increases the risk of heart disease, stroke and diabetes, in extremely obese patients can be cured by gastric bypass surgery, according to the findings from a new study.
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"Reversibility of metabolic syndrome depends more on the percentage of excess weight lost than on other clinical or demographic characteristics," the research team reports in the journal, Mayo Clinic Proceedings.

To determine the effect of major weight loss on the metabolic syndrome, Dr. Francisco Lopez-Jimenez and colleagues evaluated patients being considered for bypass surgery at the Mayo Clinic in Rochester, Minnesota, between 1990 and 2003.

All patients met at least three of the five criteria for the metabolic syndrome - high levels of triglycerides (a "bad" fat), low levels of high-density lipoprotein "good" cholesterol, increased blood pressure, high blood sugar levels and obesity.

The study group included 180 patients who underwent gastric bypass and 157 patients who did not undergo the procedure, either because they declined surgery, were denied coverage by insurance providers, or did not maintain lifestyle interventions during their evaluation. All patients received medical and dietetic care and extensive counseling about the importance of physical activity.

The mean body mass index (BMI) was 49 in the surgical group and 44 in the nonsurgical group. A normal BMI is considered to be between 18.5 and 24.9.

During an average follow-up of 3.4 years, the prevalence of metabolic syndrome decreased from 87 percent to 29 percent in the surgical group, and from 85 percent to 75 percent in the control group. The authors estimate that the number of patients needed to treat with bypass surgery to cure one patient of metabolic syndrome was 2.1.

Weight loss averaged 44 lbs in the surgical group and 0.2 lbs in the nonsurgical group. Additional analysis showed that the percentage of excess weight lost was the primary factor that determined the resolution of the metabolic syndrome.

"Our study provides robust data to practicing clinicians about the benefits of counseling weight reduction in metabolic syndrome patients," Lopez-Jimenez and his associates conclude.

They recommend "gastric bypass surgery should be considered as a treatment option in patients with metabolic syndrome that has not responded to conservative measures" in those eligible for surgery.

SOURCE: Mayo Clinic Proceedings, August 2008.

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Friday, August 15, 2008

Can gastric bypass cure diabetes?


San Francisco, CA

A new study is trying to learn whether a surgery meant to cure obesity, could also cure the symptoms of diabetes, even if the patient isn't overweight. It's a strategy that's not without controversy.
Pat Prescott is fighting to control her type 2 diabetes. She carries her blood glucose meter, a cooler for her insulin and gets regular exercise through ballroom dancing.

Still she says her symptoms have been getting worse.

"It just doesn't work anymore," said Prescott.

So when she learned that a surgery used to treat obesity has the side effect of improving diabetes, she approached her doctors, but was told she wasn't overweight enough to qualify.

Now, she's hoping to join a new clinical study, headed by surgeon Francesco Rubino. He is testing whether that same surgery, similar to gastric bypass, can improve diabetes in people who aren't obese.

"We're shifting towards a new concept, which is using surgery to intentionally treat diabetes," said Dr. Francesco Rubino from Weill-Cornell Medical School.

As he documented in the Journal Diabetes Care, when obese patients have surgery that bypasses part of their small intestine, their symptoms often disappear within days, long before they begin to lose weight.

"With some operations like gastric bypass or similar procedures, the remission of diabetes symptoms is very quick after surgery, which even precedes the weight loss," said Dr. Rubino.

In fact, researchers have known about those effects for several years. But offering gastric bypass to non-obese diabetics is controversial.

"I think it has no place outside of obesity surgery," said UCSF professor of endocrinology Dr. Robert Lustig.

Dr. Lustig says diabetes can be caused by combination of factors, including the health of beta cells, the agents in the pancreas that produce insulin.

"Diabetes is a complex disease. If you have a problem with your beta cells, then doing a bariatric surgery isn't going to rescue you," said Dr. Lustig.

Still, patients like Pat Prescott may have a part in testing the theory. Recruitment for the study begins this fall.

"I want to live long enough to enjoy my grandchildren. I want to keep dancing, I like to dance," said Prescott.

It's significant to note that the type of gastric bypass being tested in the study is performed on the small intestine, which has a complex role in how the body processes food.

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Sunday, July 20, 2008

Bariatric gastric banding and gastric bypass as cure for diabetes



It may be the closest thing to a cure for type-2 diabetes -- gastric bypass surgery.

Currently, the procedure is only performed for major weight loss.

But one surgeon hopes to prove that a similar surgery could help non-obese diabetics.

ABC's Brad Kloza introduces us to one diabetes patient who's determined to have the surgery.

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Wednesday, June 4, 2008

Is gastric bypass surgery a cure for Type 2 diabetes?


Greensboro, NC
When Dr. Enrico Jones became so overweight he could no longer work in his yard, he underwent bariatric surgery.

He expected to lose weight, and he has — 70 pounds. But he also has gotten other benefits.

In particular, combined with a diet he began before surgery, the procedure has left his Type 2 diabetes in remission. He no longer needs to take medicine to control it.

That's important because Type 2 diabetes, the most common type, can lead to blindness, kidney disease, heart disease, nerve damage and other problems. In North Carolina, the incidence of diabetes more than doubled in the past decade; more than 9 percent of the state's population now has the disease.

Researchers are now looking at whether a particular type of bariatric surgery, the gastric bypass, can be used as a direct cure for Type 2 diabetes in people who are not overweight. That's because some patients who have undergone gastric bypass surgery have seen their Type 2 diabetes disappear almost overnight.

Cris Clark of Greensboro had the procedure in December 2006. At the time, she weighed 298 pounds and suffered from Type 2 diabetes and high cholesterol, itself a risk factor for heart disease. She was taking medications for both conditions.

Her weight gradually receded to its present 180 pounds. But she was able to stop taking her diabetes and cholesterol medicines immediately.

"The day right after the surgery, I wasn't on (them) anymore," she said.

Other bariatric patients who have undergone a different procedure, in which a silicone band is wrapped around the stomach to reduce hunger — "lap band" surgery — have found that their diabetes comes under control more gradually as they lose weight. That's what happened with Jones.

How does gastric bypass affect diabetes? Researchers suspect that the answer has to do with hormones. Research with rats in which their upper small intestines were bypassed — also bypassing the pancreas, which produces insulin — found that the procedure eliminated Type 2 diabetes almost immediately. When the procedure was reversed, the rats developed diabetes again.

It is not clear whether the procedure could be used as a direct cure for Type 2 diabetes in people. The United States currently does not allow bariatric surgery on people who are not overweight. But clinical trials in Brazil are beginning to see whether such surgery can eliminate Type 2 diabetes in people who are not overweight.

"This requires much more research, which all the (medical) societies are doing," said Dr. Kristen Earle, a Greensboro bariatric surgeon. "It's an interesting finding, but it's very early. … Whenever you put a first study out there, you have to say, 'OK, what's your five-year data? What's your 10-year data?'"

Lisa White is a believer. The Gibsonville woman had lap-band surgery in 2007.

Although she did not have diabetes, both her parents did, and before the surgery, her own blood-sugar levels were approaching diabetes level. Now, they're normal.

But weight loss and diabetes control weren't the only benefits, she found.

Before surgery, her blood pressure had been 140 over 90 even with medication. Now, she says, it is 120 over 75, within the normal range.

"I'd do it again tomorrow," she said about her surgery.

Jones still has to take medication, but now his blood pressure is under control. Before the surgery, it wasn't.

He also no longer experiences the joint problems that led to his needing a hip replacement when he was still in medical school.

The painful bone spurs he used to develop in his feet are a thing of the past.

The benefits of bariatric surgery go well beyond simple weight loss, medical researchers have found. And that's good because obesity has become so common and the risks associated with obesity are so great.

About 15 percent of adult Americans were obese in the late 1970s, the U.S. Centers for Disease Control and Prevention found, but that figure had more than doubled by 2004.

In addition to high blood pressure, Type 2 diabetes and high cholesterol, obesity can increase the risk of heart disease, stroke, gall-bladder disease, sleep apnea and some cancers.

Researchers also believe that if obese people lose a significant amount of weight, they are at reduced risk of cancers of the kidney, breast, colon, liver, pancreas, ovaries, esophagus and gall bladder.

Weight loss from bariatric surgery also can eliminate sleep apnea, a condition in which a person stops breathing in his sleep multiple times during the night.

Sleep apnea doesn't just cause poor sleep. It also puts people at increased risk for heart attacks, strokes, high blood pressure, obesity and diabetes.

Weight loss from bariatric surgery can even reduce the incidence of erectile dysfunction and other sexual problems in obese men, new research suggests.

The benefits of bariatric surgery are not widely spread so far because only about 1 percent of Americans who are eligible for bariatric surgery have had it, CBS' "60 Minutes" has reported. It can cost $25,000 or more, and insurance doesn't always cover it.

But Jones found his procedure worthwhile, in part because he's back working in his yard. He has always loved doing that, but in the summer of 2006 he realized he had grown so heavy he no longer had the energy.

Now, since losing those 70 pounds, "my feet don't hurt anymore, and I'm back to cutting my grass."

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Monday, May 19, 2008

Doctor recommends gastric bypass as way to prevent diabetes


New York, NY

Research shows weight loss surgery may be able to completely reverse Type 2 diabetes, as close to 90 percent of those with the disease are overweight, but the numbers of people getting the surgery are still small. NY1 Health & Fitness reporter Kafi Drexel has more on why this may be and what doctors are hoping can be done about it.
Before undergoing gastric bypass surgery, Judy Grant, 58, was 306 pounds and suffered from Type 2 diabetes. Now a year later, she's more than 100 pounds lighter and all signs of Type 2 are gone.

"I wasn't insulin dependent yet, but that was coming," she said. "And I knew that I was quickly approaching that because I was just having so much trouble and it took so much to manage me and I was thinking, 'If I continue on, where will I be?'"

Obesity is a leading cause of Type 2 diabetes. Doctors say weight loss surgery, also known as bariatric surgery, works because it leads to long-term weight loss, which helps lower blood sugar levels. Some of the latest research shows that diabetes goes away in many patients who undergo gastric bypass even before they start losing significant amounts of weight.


"In more than 434 patients who underwent gastric bypass, 89 percent of those have completely eliminated diabetes," said Dr. Piotr Gorecki. "We still call it suppression, rather than a cure, because still certain factors may be important there. But for practical reasons, they do not take their medicine, their glucose levels are normal, and they do not have any other features of diabetes as a disease."

Gorecki points out even those patients who are not "cured" so-to-speak are seeing significant improvements.

Despite the successes, there are still relatively few people undergoing the procedure. Guidelines from the National Institutes of Health, written nearly two decades ago, say only the morbidly obese should be eligible, possibly putting up roadblocks for potentially millions of mildly obese patients who could benefit.

Doctors, like Gorecki, who see the benefits in patients say it is time those guidelines start to be re-evaluated.

"Since both of these diseases, obesity and diabetes, are so prevalent and are so epidemic on such a large scale, this will be a major issue for insurance companies, for all third-party payers, including the government, for medical and surgical societies to come up with new guidelines," he said.

But with no plans in the works to revise guidelines, doctors or patients will probably not see any change to guidelines overnight. They say the hope is that continued evidence pointing to improved health benefits will change the outlook.

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Sunday, May 4, 2008

Gastric bypass surgery shows promise for treatment of diabetes


Washington, D.C.
Rocco Turso was injecting himself with insulin three times a day, swallowing pills twice daily and restricting his diet. But his diabetes was still out of control, blurring his vision, making his feet numb and sapping his energy. So he decided to try an experimental operation. Within days, his blood sugar was normal and he was off all his medications.

"It's been truly amazing," said Turso, 62, a construction superintendent from Harrison, N.Y. "I use the word 'miracle.' The diabetes was killing me. It's given me back my life."

Turso is one of a handful of Americans who have undergone a novel procedure that proponents say appears to offer the most important advance since the discovery of insulin in treating one of the most common chronic diseases.

"It's extremely promising," said Madhu Rangraj, chief of laparoscopic surgery at the Sound Shore Medical Center in New Rochelle, N.Y., who performed the operation bypassing part of Turso's small intestine in March. "It's a surgical solution to diabetes."

While many surgeons share Rangraj's enthusiasm, and some diabetes experts agree that the operation and similar ones may lead to fundamental new insights into the disease, other experts remain cautious. Much more research is needed, they say, to validate the effectiveness of the procedures. They worry that the operations will start to proliferate before their long-term safety and effectiveness have been proven, as often occurs with novel surgeries.

"I'm skeptical," said R. Paul Robertson, president-elect of the American Diabetes Association. "It bothers me to see this message being put out there that we can now cure diabetes through surgery. They have to prove that to me."

Turso's operation is a variation of a procedure developed to treat severe obesity. Known as bariatric surgery or gastric bypass, the standard operations reduce the size of the stomach and bypass part of the intestine. That limits the amount of food a person can eat and the calories that can be absorbed. The procedures have soared in popularity as the obesity epidemic has spread and clinical trials have validated their safety and effectiveness. More >>

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Sunday, April 27, 2008

More from 60 Minutes: The gastric bypass effect on diabetes, cancer



It's pretty well known to doctors that the most successful treatment for obesity is surgery, especially the gastric bypass operation. But here's something the medical world is just realizing: that the gastric bypass operation has other even more dramatic effects. It can force type 2 diabetes into almost instant remission and it appears to reduce the risk of cancer.

Surgeons have been performing bariatric, or weight loss operations since the 1950s, but they're much safer than they used to be. They're typically done laparoscopically now, where doctors use tiny surgical tools and video cameras instead of making big, deep incisions.

Despite the increase in obesity, only a small number of people have had the gastric bypass operation. Read more More from 60 Minutes: The gastric bypass effect on diabetes, cancer >>

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Sunday, April 20, 2008

60 Minutes segment on gastric bypass surgery effect on diabetes, cancer


60 Minutes reports: Gastric bypass surgery can send diabetes into remission and may reduce risk of other cancers.
It's pretty well known to doctors that the most successful treatment for obesity is surgery, especially the gastric bypass operation. But here's something the medical world is just realizing: that the gastric bypass operation has other even more dramatic effects. It can force type 2 diabetes into almost instant remission and it appears to reduce the risk of cancer.

Surgeons have been performing bariatric, or weight loshttp://www.blogger.com/img/gl.link.gifs operations since the 1950s, but they're much safer than they used to be. They're typically done laparoscopically now, where doctors use tiny surgical tools and video cameras instead of making big, deep incisions.

Despite the increase in obesity, only a small number of people have had the gastric bypass operation. More >>

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Wednesday, February 20, 2008

Gastric bypass surgery may help cure diabetes



Alexandria, LA
A lot of people would consider surgery a drastic measure for treating diabetes.

But, a well-respected study, finds gastric lap-band or gastric bypass surgery may help cure the disease.

Even though 50 year old Ben Hunter was obese he didn’t get gastric bypass surgery to lose weight.

“I did it because I had diabetes that was out of control.” said the one time 313 pounder.

And it worked.

According to a new study of 60 diabetic patients, weight loss surgery controls and cures diabetes in 80 percent of the people who had it done.

That compares to about 10% who got treated with medication.

Dr. Alan Whittgrove a bariatric surgeon said, “Very few of them got control of their diabetes with medical treatment whereas with the weight loss from the adjustable band almost 80% lost their diabetes along with loosing their weight.”

It works like this, a lap-band is tightened around the stomach to make it smaller, so you eat less food and lose weight, which controls diabetes.

In gastric bypass surgery, the intestine is cut and re-attached to the stomach, so food is not absorbed in the usual way which also controls and sometimes cures diabetes. More>>

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posted by iLitigate at 0 Comments

Gastric bypass surgery may help cure diabetes



Alexandria, LA
A lot of people would consider surgery a drastic measure for treating diabetes.

But, a well-respected study, finds gastric lap-band or gastric bypass surgery may help cure the disease.

Even though 50 year old Ben Hunter was obese he didn’t get gastric bypass surgery to lose weight.

“I did it because I had diabetes that was out of control.” said the one time 313 pounder.

And it worked.

According to a new study of 60 diabetic patients, weight loss surgery controls and cures diabetes in 80 percent of the people who had it done.

That compares to about 10% who got treated with medication.

Dr. Alan Whittgrove a bariatric surgeon said, “Very few of them got control of their diabetes with medical treatment whereas with the weight loss from the adjustable band almost 80% lost their diabetes along with loosing their weight.”

It works like this, a lap-band is tightened around the stomach to make it smaller, so you eat less food and lose weight, which controls diabetes.

In gastric bypass surgery, the intestine is cut and re-attached to the stomach, so food is not absorbed in the usual way which also controls and sometimes cures diabetes. More>>

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Tuesday, January 22, 2008

Study: Obesity surgery can cure diabetes


Chicago, IL
A new study gives the strongest evidence yet that obesity surgery can cure diabetes. Patients who had surgery to reduce the size of their stomachs were five times more likely to see their diabetes disappear over the next two years than were patients who had standard diabetes care, according to Australian researchers.

Most of the surgery patients were able to stop taking diabetes drugs and achieve normal blood tests.

"It's the best therapy for diabetes that we have today, and it's very low risk," said the study's lead author, Dr. John Dixon of Monash University Medical School in Melbourne, Australia.
The patients had stomach band surgery, a procedure more common in Australia than in the United States, where gastric bypass surgery, or stomach stapling, predominates.

Gastric bypass is even more effective against diabetes, achieving remission in a matter of days or a month, said Dr. David Cummings, who wrote an accompanying editorial in the journal but was not involved in the study.
"We have traditionally considered diabetes to be a chronic, progressive disease," said Cummings of the University of Washington in Seattle. "But these operations really do represent a realistic hope for curing most patients."
gastric bypass malpractice lawsuits

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