New research released today reveals the startling impact of weight loss surgery on curing type 2 diabetes. UK researchers found almost three quarters of obese type 2 diabetic patients (72 per cent) who underwent gastric bypass procedures showed no clinical signs of type 2 diabetes after two years. Remission of Type 2 diabetes after gastric bypass and banding: mechanisms and two year outcomes. The results, which offer a solution to help stem the global diabetes epidemic with significant clinical and economic impacts, are published in the December issue of the Annals of Surgery.

The study, included 34 obese patients with type 2 diabetes who had undergone bariatric surgery, and not only demonstrated significant weight loss of almost a third (30.6 per cent) but the majority (72 per cent) of gastric bypass patients were cured of their diabetes; a chronic condition linked to obesity. A second part of the research found that all bypass patients experienced an increase in insulin production and an improvement in insulin resistance within only one week of surgery.

Dr Carel Le Roux, one of the team of researchers and a member of ESCO, the independent multi-disciplinary group made up of experts in severe and complex obesity management, commented: “Our research has demonstrated for the first time how bariatric surgery offers a ‘double whammy’ in terms of the effect on type 2 diabetes. By increasing the amount of insulin produced and improving the body’s sensitivity to the blood sugar-regulating hormone, obese diabetic patients can be effectively cured of the condition.”

Although the mechanisms remain unclear, the study suggests that the radical remission of type 2 diabetes following gastric bypass surgery cannot be attributed to weight loss alone, since improvements were witnessed ahead of any reduction in weight.

The most likely explanation for the improved control of blood sugar lies in the effect the surgery has on key gut hormones, known as glucagon-like peptides (GLP-1). These hormones are thought to mimic the hormones responsible for initiating insulin release from the pancreas, thus helping to restore blood sugar levels to normal.

The results of the study have significant implications for patients and for the NHS budget. It is estimated that the current NHS spend on diabetes is around £9 billion, treating the 2.5 million people suffering with type 2 diabetes, with a drug bill of nearly £650 million in 2009/10; more than 40 per cent up on five years earlier.

Richard Welbourn, Bariatric Surgeon, performing surgeon for all 34 operations studied and member of ESCO, comments: “For the first time we are seeing significant results with patients going in to remission from their diabetes in the UK. The savings to NHS expenditure are going to be considerable and beneficial to the wider economy as patients come off benefits, and many of those who are unable to work as a result of either their obesity or diabetes, find jobs and contribute to the GDP.”

“Bariatric surgery has the potential to stem the rise in new cases of type 2 diabetes, currently estimated at 100,000 every year, as well as improve the outlook and quality of life for thousands of sufferers. One patient, Mr SG, had tried everything to improve his health and eventually had to resort to surgery to cure his diabetes,” continued Dr Le Roux, “Not only is he free of a chronic health condition, but the reduction in drug costs and the fact he is still able to work demonstrates how bariatric surgery offers real savings for the NHS as well as the wider economy.”

Mr SG, a 40 year old truck driver from Milton Keynes was cured of his type 2 diabetes in under a week following the weight loss surgery.

Prior to the procedure, Mr SG was unable to take insulin to help control the condition due to DVLA restrictions on his heavy goods licence that would result in him being declared unfit for work. As such, he had poor control of his diabetes and required maximum anti-diabetes medication, costing the NHS over £120 per month. Despite efforts to improve his diabetes by losing weight, there was no improvement in Mr SG’s condition.

In November 2010 he underwent gastric bypass surgery at the Imperial Weight Centre and was discharged without any complications two days later. By day five following surgery, his diabetes had gone into remission and medications were stopped. Mr SG now has the blood glucose levels associated with a healthy adult and is looking forward to getting back to work behind the wheel.

Mr SG commented: “I had tried everything to lose weight and despite losing more than two stone my diabetes showed no signs of improvement. It was a case of getting my diabetes under control or losing my job and being forced to claim benefits. The surgery has changed my life and means I no longer need to take any diabetes medication, with the added benefit of helping me to lose weight and reduce the risk of other serious illnesses.”

Notes:

· The study followed 34 of such patients undergoing gastric bypass or banding procedures by the same surgeon at Musgrove Park Hospital, Somerset between 2004 and 2007.

· Remission of type 2 diabetes was defined as:
– Patients not requiring anti-diabetic medication
– Fasting glucose levels below 7mmol/L (normal below 6mmol/L)
– Two-hour blood glucose levels below 11.1mmol/L following an oral glucose tolerance test as specified by the World Health Organisation
– Glycated haemoglobin below 6% thee months after last use of anti-diabetic medication

· Diabetes is a condition where the amount of glucose in your blood is too high because the body cannot use it properly. Type 1 diabetes occurs when your pancreas does not produce any insulin to help glucose enter your body’s cells. Type 2 diabetes occurs either when not enough insulin is produced by the pancreas or the insulin that is produced does not work properly (known as insulin resistance).

· There are currently around 2.5 million people estimated to suffer from type 2 diabetes in the UK.

· ESCO (Experts in Severe and Complex Obesity), is a group which comprises some of the foremost obesity experts in the UK, and is tasked with reducing the inequalities of obesity and its management.

References

1. Pournaras DJ, Osborne A et al. Remission of Type 2 diabetes after gastric bypass and banding: mechanisms and two year outcomes. Ann Surg. 2010 Dec;252(6):966-71.

2. Turning the corner improving diabetes care. Department of Health, June 2006.

3. Prescribing for diabetes in England: 200405 – 2009-10. NHS Information Centre for Health and Social Care. July 2010.

4. World Health Organisation. Definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO Consultation, Geneva, Switzerland; 1999.

5. Diabetes UK website. [Accessed December 2010] – taken as 90% of all UK diabetics.

Source: ESCO (Experts in Severe and Complex Obesity)