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Bariatric surgery may improve and reverse diabetes: Cleveland Clinc study shows procedure can lead to fewer medications.

If you're obese and have type 2 diabetes, you may see a reversal of the disease and a reduction, if not elimination, of diabetes medications if you under go bariatric surgery.

Cleveland Clinic researchers, led by Philip Schauer, MD, director of the Cleve land Clinic Bariatric and Metabolic Institute, found that weight-loss surgery helped such patients achieve normal Gastric bypas: blood sugar levels with have a section out the use of any dia-attached to a betes medications. The the top of the s patients will continue to be followed for the next four years to determine whether the blood sugar levels achieved after the procedure can be maintained in the long run.

The initial study, published March 26 in the New England Journal of Medicine, involved 150 patients with obesity and poorly controlled diabetes. The patients were divided into three groups: those who received intensive medical therapy; those who received medical therapy and gastric bypass surgery; and those who received medical therapy and a sleeve gastrectomy.

"After one year, patients who underwent gastric bypass or sleeve gastrectomy lost more weight and were significantly more successful at controlling their diabetes, compared to those who simply took medications," says Dr. Schauer. "We believe that bariatric surgery represents a potentially valuable strategy for control of diabetes that should be considered in more patients who do not respond to conventional treatment."

Surgery options

Weight-loss surgery isn't for everyone, but studies have shown that older, obese adults can safely undergo the operation and achieve healthy out comes. The type of surgery you have will depend on your overall health and any medical conditions you're currently dealing with, as well as your preferences and the recommendations of your doctors.

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Gastric bypass surgery involves the stapling of your stomach into upper and lower sections. The upper section is known as the pouch and will be created to hold a very limited amount of food at one time. A section of small intestine will then be attached to the pouch, allowing food to bypass the larger portion of the stomach and go straight from the smaller stomach section into the small intestines. Your body will absorb fewer calories this way.

The sleeve gastrectomy actually involves the removal of a significant portion of the stomach, again to limit the amount of food you can eat in one sitting.

After the surgeries

The amount of weight loss from each procedure is often extraordinary within the first year, but the key to sustained success after weight-loss surgery is following a diet of small, healthy meals. The stomach can stretch, so even if you have one of the weight-loss surgeries described above, the weight can return if you're not careful.

Aside from the many benefits of these weight-loss approaches, such as a reduced burden on the heart and joints, surgical patients with diabetes often find they can achieve normal blood glucose levels without medications. In the Cleveland Clinic study, for example, all of the gastric bypass patients who reached their target blood glucose levels, did so without any diabetic medications. About 72 percent of the sleeve patients who reached their levels did so without any diabetic medications. In those patients who did require drugs to maintain normal blood glucose levels, they experienced a reduction in the amount of medications they needed.

"This trial demonstrates that bariatric surgery can eliminate the need for diabetes medications in many obese patients whose diabetes is poorly controlled: Dr. Schauer says. "Furthermore, the surgical patients showed major improvements in other measures of heart health, including reduced need for high blood pressure and cholesterol medications, while significantly boosting HDL, the so-called 'good' cholesterol."

Bariatric surgery is not only a major operation, it requires a significant lifestyle change afterwards. If your doctor feels you may be a good candidate for weight-loss surgery, be sure to have a detailed conversation about the risks, benefits and requirements for maintaining your health and reduced weight long after the procedure.

WHAT YOU CAN DO

* Bariatric surgery is not for individuals who need to lose 10 or 15 pounds, but for those who need to drop about 50 pounds or more.

* About 10 percent of bariatric surgery patients experience post surgical complications such as minor bleeding and abdominal hernia.

* Vitamin and nutritional deficiencies can occur due to changes in the way the body absorbs food after surgery, which means careful meal planning is essential.
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Title Annotation:PREVENTION
Publication:Heart Advisor
Date:Jun 1, 2012
Words:732
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