Is Gastric Bypass Surgery a Cure?
Gastric bypass surgery is getting more and more attention as a potential cure for type 2 diabetes. For example, Dan Hurley's outstanding recent book Diabetes Rising, which I reviewed here, included it in the author's section on cures for diabetes.
Usually people define a cure based on fasting blood glucose and A1C tests. Anna L. Marina, M.D., a primary author of the case study, and her associate, Dace Trence, M.D., described a case that met those criteria, "but did not support remission of diabetes on further evaluation."
Dr. Marina is a senior clinical research fellow in the division of metabolism, endocrinology, and nutrition of the University of Washington. Dr. Trence is associate professor of medicine there.
Dr. Anna Marina
Dr. Marina presented her findings at a press briefing during the annual meeting and clinical congress of the American Association of Clinical Endocrinologists in Boston today. I am attending this meeting to represent Health Central.
The subject of Dr. Marina's presentation was a 55-year-old man who was morbidly obese with a BMI of 45.2 and who had had type 2 diabetes for seven years. He had undergone Roux-en-Y gastric bypass surgery, by far the most commonly performed bariatric procedure in the United States.
The surgery obviously helped him a lot. Right after his operation he was able to cut his insulin injections from 100 to 30 units a day. After four months he had lost more than 100 pounds and his A1C went from 9 to 6.1 percent. At that point he and his doctor decided that he didn't need insulin any more.
But after seven months he started having post-meal blood glucose levels in the 180 mg/dl range. Then, as tested with a continuous blood glucose monitor, they could see that his post-meal levels were often in the 200 mg/dl range -- all the way up to 294 mg/dl. Those levels are consistent with a diagnosis of diabetes.
This is also consistent with another recent study, Dr. Marina said. Dr. Mitchell Roslin and two associates reported at last year's annual meeting of the American Society for Metabolic and Bariatric Surgery. They performed glucose tolerance tests on 38 people more than six months after they had Roux-en-Y gastric bypass surgery.
"They found that six out of these 38 people still had diabetes," Dr. Marina said. She concluded that "fasting blood glucose and normal A1C are insufficient to establish that gastric bypass surgery is a cure for type 2 diabetes."
Gastric bypass surgery is a last resort. It can work for some people with diabetes who are morbidly obese. But unfortunately not for all.