by Alan C. Wittgrove, MD, Scripps Memorial Hospital La Jolla
Earlier this year, the news that bariatric surgery could help treat type 2 diabetes in individuals who suffer from morbid obesity (defined as those with a body mass index or BMI over 35) made headlines around the world. The American Journal of Medicine reported that bariatric surgery, including gastric bypass procedures, led to resolution or improvement of type 2 diabetes in nearly 90 percent of cases.
At Wittgrove Bariatric Center at Scripps Memorial Hospital La Jolla, more than 90 percent of our patients with morbid obesity and type 2 diabetes who undergo gastric bypass surgery can stop taking all of their diabetic medications and have normal blood sugar levels within three days following the procedure. While both gastric bypass surgery and gastric band surgery have shown success in treating diabetes in patients with morbid obesity, gastric bypass has been found to be more effective than banding and have longer-lasting results.
Recently, new research has suggested that gastric bypass surgery may also help combat diabetes in people who do not have morbid obesity. Originally, we believed the main reason for the resolution or improvement of diabetes in morbid obesity was the amount of weight lost as a result of the gastric bypass surgery. However, we now understand that the effect of the gastric bypass goes beyond the restriction of food intake and subsequent weight loss. In fact, the effect is metabolic in nature; it appears that gastric bypass surgery changes the way food is routed through the gastrointestinal tract, and that this change can resolve type 2 diabetes in people who are overweight. This effect is seen within days after surgery and is most dramatic in patients who have had the diagnosis of diabetes for less than eight years.
What does this mean if you have type 2 diabetes and are not morbidly obese? We believe all indications are that the metabolic effects we see on diabetes after gastric bypass surgery on morbidly obese patients with a BMI above 35 may also be seen in patients who have a BMI of 25 to 35. Wittgrove Bariatric Center is one of only a handful of programs throughout the country that can offer gastric bypass for patients who have type 2 diabetes and are not morbidly obese; rather, the reason for the surgery is diabetes alone.
Wittgrove Bariatric Center has obtained an IRB approval from Scripps Memorial Hospital to investigate the effect of this surgery on diabetes in patients with BMIs between 27 and 35. I cannot overstate the importance of an IRB approval: an IRB is an institutional board which helps to ensure the rights of the patients while studies are being done. The board is made up of doctors and community lay persons whose job is to ensure the study has enough merit and a safe risk benefit ratio. We believe this surgery will probably offer the best sugar control for type 2 diabetes without the need for medications.
_Alan C. Wittgrove, MD, is medical director of the bariatric program at Scripps Memorial Hospital La Jolla. “To Your Health” is brought to you by the physicians and health care professionals at Scripps La Jolla. _
- Lisa Ohmstede