Diabetics turn to weight-loss surgery
Operation can stem the disease in obese patients
LOS ANGELES — For nearly a decade, Cristina Iaboni tried to tame her diabetes the usual way, through daily shots of insulin and other medicine.
Still, her blood sugar raged out of control. So Iaboni combed the Internet for another solution and found a doctor who is testing weight loss surgery on diabetics who, like her, are overweight or a tad obese, in an attempt to curb the chronic disease.
Scientists in recent years have discovered that diabetes all but disappears in some obese patients soon after the operation. Many were able to achieve normal blood sugar and ditch their medications.
Does the benefit extend to diabetics who are not quite as hefty? Performing surgery on the slightly overweight with the goal of reversing diabetes is provocative. Iaboni’s surgeon is one of a handful of doctors around the world stretching the rules to determine whether the gastric bypass surgery helps.
Iaboni had the surgery last fall at New York-Presbyterian/Weill Cornell Medical Center as part of a study. In gastric bypass or stomach stapling surgery, the stomach is reduced to a thumb-size pouch that holds less food.
Now 50 pounds lighter, she has stopped taking diabetes medications. Her blood sugar is almost normal.
“I didn’t care if I lost any weight. I just wanted the diabetes to go away,’’ said the 45-year-old Connecticut mother of two teenagers.
The twin epidemics of obesity and diabetes are fueling an international public health threat. In the United States, one out of five people with obesity-linked Type 2 diabetes are morbidly obese — defined as 100 pounds overweight.
Surgery is generally a last resort after traditional ways to shed the pounds, such as diet and exercise, fail. Even so, there are strict rules for who can go under the knife.
Federal guidelines say surgery candidates must be morbidly obese with a body mass index over 40, or a BMI over 35 plus a weight-related medical problem, such as diabetes or high blood pressure. Insurers use the cutoffs in deciding whether to pay for the procedure.
BMI is a calculation of height and weight used to estimate body fat. Overweight begins at a measurement of 25, obese at 30, and morbidly obese at 40. A 5-foot-6 person is considered overweight at 155 pounds, obese at 186 pounds, and morbidly obese at 248 pounds. The current BMI limits for obesity surgery were set by the National Institutes of Health in 1991.
Dr. Philip Schauer of the Cleveland Clinic is among those pushing the BMI envelope. For a study, he’s recruiting 150 overweight and obese diabetics with BMIs between 27 and 43. Some will have surgery and their progress will be compared with those who manage their diabetes with medicine. The goal is to see which group can achieve complete remission.
Smaller studies have hinted that stomach stapling and gastric banding — in which an adjustable ring is placed over the top of the stomach to create a small pouch — may work in diabetics who aren’t so fat.
“These procedures can cause long-term remission and restore someone to normal blood sugar levels without medication,’’ Schauer said.
How does the surgery help some diabetics beat the disease? Doctors don’t exactly know, but there is some evidence that it may not all be due to weight loss. Diabetes occurs when the body can’t regulate blood sugar, and some researchers think that the rerouting of the digestive tract after the operation affects the gut hormones involved in controlling blood sugar.
Last year, 220,000 people had obesity surgery, which can cost between $14,000 and $26,000, according to the American Society for Metabolic and Bariatric Surgery.
In a 2009 study, death, serious complications, or the need for a repeat procedure occurred in 1 percent who received bands, about 5 percent who had minimally invasive gastric bypass, and nearly 8 percent who had traditional bypass.
The American Diabetes Association said there is not enough evidence to generally recommend surgery for diabetics with a BMI lower than 35 outside of an experiment.