Until then reserved as a last option, obesity surgery allows patients to lose several tens of pounds but also to treat their diabetes in three-quarters of cases.
In France, obesity surgery is only considered as a last resort. It is reserved for patients suffering from severe obesity, with a body mass index greater than 35 and resistant for several years to any other treatment (dietetics, physical education, etc.) Two new studies presented at the American Congress of Cardiology could change the situation . They show that operating on an obese is much more effective in treating type 2 diabetes than the classic trio of diet, exercise and anti-diabetic drugs. Two years after their operation, 75 to 95% of patients had returned to normal blood sugar levels, otherwise said their diabetes was in remission, compared to none of the patients who were taking the medication.
A large Swedish study had already observed the beneficial effects of obesity surgery on type 2 diabetes. The strength of these new studies is to confirm these results by having decided by lot to treat each patient with medication or surgery, which is called a randomized study.
The extent of these good results leads specialists to wonder: why keep surgery as the last option? Knowing that one in 2 diabetics also suffers from obesity, could surgery not be useful for diabetic patients whose obesity is less severe?
Prof. Arnaud Basdevant, Nutrition unit, La Pitié-Salpêtrière, Paris: “We are moving towards digestive surgery to treat diabetes”
But what holds back specialists is that obesity surgery, also called bariatric surgery, is really not a trivial operation. There are 2 major surgical techniques to reduce the amount of food eaten. Either the capacity of the stomach is restricted by the placement of a gastric band or by the removal of part of the pouch; either the stomach is largely bypassed, this is called the gastric bypass or bilio-pancreatic bypass depending on where the bypass is “connected” to the intestine. As with any surgery, there can be complications and the after-effects are not uncommon: reflux, diarrhea, vitamin deficiencies, etc.
There is therefore a long way to go before making surgery the treatment of choice for type 2 diabetes in all obese people. Especially since the probability is high that diabetes will disappear with surgery but come back later.
Prof. Arnaud Basdevant: “Ten years without hyperglycemia is always a winner! “
In addition, we know that obesity surgery has other benefits than treating diabetes. It relieves the heart and blood vessels by reducing high blood pressure and death from infarction or stroke. Last October, an American study even showed that the operation of an obese person was beneficial to their entire family by encouraging everyone to eat better and exercise more.
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