Weight Loss Surgery Fights Diabetes in Multiple Ways

Researchers Say Changes in Gut Hormones, Along With Weight Loss, May Improve Type 2 Diabetes

June 24, 2011 (San Diego) -- Gastric bypass surgery often helps to improve type 2 diabetes -- even before patients lose a substantial number of pounds, doctors say.

"We used to think bariatric surgery worked for purely mechanical reasons. That is, caloric restriction and decreased nutrient intake were responsible for the improvements in diabetes control," says Lee M. Kaplan, MD, PhD, director of the obesity research center at Massachusetts General Hospital in Boston.

New research shows that physiological changes associated with weight loss surgery, such as changes in gut hormones, may also help to drive diabetes into remission, he tells WebMD.

At a briefing that was sponsored by Ethicon Endo-Surgery, a maker of bariatric surgery products, Kaplan and other leading experts discussed how they are working to understand the mechanisms of weight loss surgical procedures at the tissue, cellular, molecular, and genetic levels.

The goal is to develop less invasive, less risky, and less costly approaches to fighting diabetes, says Philip Schauer, MD,professor of surgery at the Cleveland Clinic Lerner College of Medicine.

Extreme obesity, which affects nearly 24 million adults, or 5.7% of Americans, is associated with more than 30 medical conditions, including type 2 diabetes, coronary heart disease, stroke, hypertension sleep apnea, joint disease, and cancer.

"Bariatric surgery works and works well -- for both obesity and diabetes," Schauer says.

In a recent study, 89% of people with type 2 diabetes who underwent gastric bypass surgery went into remission and 57% were still in remission after five years.

People who were at an early disease stage when they had the surgery were more likely to go into remission, Schauer says. "The first five or 10 years is when you have the best chance of recovery."

Although weight loss surgery is effective, there has been very little adoption of its use, Kaplan says.

Only one in 400 people with severe obesity in the U.S. undergoes bariatric surgery, he says.

The cost of treating diabetes is enormous, Schauer says. A person diagnosed at age 50 can expect to spend $172,000, the equivalent of seven gastric bypass procedures, on the condition.

The researchers don't know when new treatments aimed at the hormonal and genetic roots of diabetes will become available. But at least 12 studies are under way, Schauer says.

Treating Relapsing Multiple Sclerosis

Living with multiple sclerosis means living with uncertainty. The course of the disease is very difficult for doctors to predict. Some people live with MS for years without suffering serious symptoms. Others may rapidly become disabled. Why the course of the disease varies so widely remains unclear. One thing is certain. Most people with MS experience periodic relapses, also called flare-ups or attacks. These can be mild or severe. They may show up in many different ways. Symptoms can include:

Muscle weaknessVisual disturbancesBalance problemsMemory lossLoss of bowel or bladder control

“Between 85% and 95% of MS patients begin with what we call remitting/relapsing MS,” says Anne Cross, MD, professor of neurology at Washington University School of Medicine. During that phase of the disease, the pattern of relapses varies widely among patients. Some people have frequent relapses. Others have very few. The average is typically one to two attacks a year, according to Cross.  

Doctors can help MS patients live as active and normal a life as possible by treating acute relapses as soon as they occur. Yet there are instances when doctors may recommend not treating a relapse.

Doctors follow two basic strategies in treating multiple sclerosis. To slow the long-term progression of the disease, doctors prescribe “disease-modifying” agents. The most commonly used drugs are interferon (Avonex and Rebif ), fingolimod (Gilenya), mitoxantrone (Novantrone), and natalizumab (Tysabri). 

Research shows that these disease-modifying drugs can decrease the rate of relapses by about 30%. They also lessen the severity of relapses. Not all forms of MS respond to these drugs, however. And even when the drugs work, they do not offer a cure. Most people continue to experience periodic relapses.  

When acute attacks occur, doctors can suppress the underlying autoimmune damage, which is at the heart of MS, with the use of corticosteroids. Studies have shown that corticosteroid treatments significantly reduce the severity and shorten the duration of relapses for most patients. A typical dose is between 500 and 1,000 milligrams of intravenous methylprednisolone, which is gradually reduced over several weeks.

“But there is no clear-cut best way to administer corticosteroids, so doctors usually go on the basis of their own clinical experience with the disease,” says Ben W. Thrower, MD, medical director of the Andrew C. Carlos Multiple Sclerosis Institute at the Shepherd Center in Atlanta.

Even when they are untreated, however, acute relapses of MS typically resolve on their own over a matter of days or weeks. For that reason, and because corticosteroids are powerful drugs with some unwanted side effects, doctors may recommend using them only for relapses that significantly affect a patient’s function. Adverse side effects of corticosteroids can include fluid retention, weight gain, elevated blood pressure, and mood swings.