Weight-loss surgery better than medications to treat diabetes in morbidly obese

Sleeve gastrectomy surgery is more effective than conventional medical therapy for reversing type 2 diabetes in the morbidly obese, according to a study published in Archives of Surgery.

Sleeve gastrectomy is a type of weight-loss surgery in which 80 to 85 percent of the stomach is surgically removed. The stomach becomes the size and shape of a banana, according to the National Institutes of Health (NIH). The smaller stomach limits the amount of food you can eat by making you feel full after ingesting small amounts of food.

The study conducted in Italy analyzed 30 morbidly obese patients with type 2 diabetes who underwent sleeve gastrectomy and another 30 who underwent conventional medical therapy.

For 80 percent of surgery patients, their diabetes was resolved after the sleeve gastrectomy procedure.

The surgery group had a body mass index (BMI) of 41.3 before surgery, which dropped to 28.3 at 18 months after surgery. Their fasting plasma levels dropped from 166.6 mg/dL before surgery to 96.2 mg/dL a year and a half later. Likewise, their hemoglobin A1c levels declined from 7.9 percent to 6.0 percent.

Meanwhile, all patients in the group that underwent conventional medical therapy remained diabetic after 18 months.

At the beginning of the study, their BMI, fasting plasma glucose level, and hemoglobin A1c level were 39.0, 183.7 mg/dL, and 8.1 percent, respectively. At 18 months, those values were 39.8, 150 mg/dL, and 7.1 percent, respectively.

Vertical sleeve gastrectomy
Vertical sleeve gastrectomy is typically considered only for the very obese who have been unable to lose weight through diet and exercise, according to NIH.

It is recommended for individuals with a BMI of 40 or more and at least 100 pounds over their recommended weight. A normal BMI is between 18.5 and 25.

It may also be recommended for people with a BMI of 35 or more who also have a serious medical condition that might improve with weight loss. These conditions include type 2 diabetes, heart disease, and sleep apnea.

Risks for any surgery include blood clots, blood loss, heart attack or stroke during surgery, and infection.

Risks for sleeve gastrectomy include gastritis, heartburn or stomach ulcers, injury during surgery, leaking from parts of the stomach that are stapled together, poor nutrition, belly scarring and bowel blockage, and vomiting from overeating.

Once performed, the procedure cannot be reversed.

Sources: Archives of Surgery, National Institutes of Health

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