A "Cure" For Type II Diabetes? YES!!

YES!  An actual cure for diabetes.

When looking at the typical bariatric surgeries there are many benefits to a Type II diabetic but one stands out above and beyond the rest!

Duodenal Switch.

Lap bands have an extremely high failure rate, I sincerely wish the FDA would take them off the market. Bands have been around since the 1970s and the stats are no better today with new technology than they were in the 70s. Diabetes remission is going to be temporary due to faulty bands needing to be removed.

Sleeves, diabetes usually improves drastically by about 10 days to 2 months post op, (my experience with patients). Again, remission but not a cure.

RNY- A Welsh study that came out about 5 years ago or so shows that diabetes goes into remission in 80+% of patients within 10 days of surgery. It is due to the change in the hormonal chain reaction in the gut due to surgery. However, with bypass diabetes comes back in 1/3 of bypass folks.

Duodenal Switch, whole different ballgame. 98.9% of patients experience a cure before they ever leave the hospital. Not remission, a cure.

Check it out:

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Diabetes Cure with Duodenal Switch

Obesity is the leading cause of Type II diabetes mellitus (adult onset diabetes) in the United States. With sufficient weight loss, diabetes will in most cases improve or resolve. Walter Poires, M.D. published in 2004 a study outlining the improvement in Type II diabetes after Roux-En-Y gastric bypass. Since we began performing the Duodenal Switch (DS) in 1993, we have observed that the majority of our patients following their DS for their morbid obesity have had their diabetes cured immediately following the surgery. In fact, we have seen a remarkable 97% recovery rate for our patients with diabetes. Many of our patients discontinue their insulin and/or oral hypoglycemic medications prior to their hospital discharge.

This phenomenon of immediate cure of the diabetes following the DS is, in large part, due to the intestinal rearrangement that is a component of the procedure. We have found that the improvement in and cure of Type II diabetes mellitus following weight loss surgery is, by far, most dramatic following the Duodenal Switch. We routinely perform the DS laparoscopically (LapDS) since we pioneered this minimally invasive approach in 1999.

Below is a chart outlining the differences following weight loss surgery in the cure and or reduction of diabetes and other serious morbid obesity related diseases reported by Harvey Buchwald, M.D. in his meta analysis published in 2004. In this study over 20,000 postoperative bariatric patients were followed for up to 13 years.

Obesity Related Illnesses that Improved/Resolved Following Weight Loss Surgery:

Diabetes Mellitus :
Gastric Band 47.9% 
RnY (gastric bypass) 83.7% 
Duodenal Switch 98.9%

Buchwald, H. Bariatric Surgery, A Systematic Review and Meta-analysis. JAMA, October 13, 2004-Vol 292, No. 14
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One interesting issue to note, when people have bypass (RNY) only 80+% go into "remission" and diabetes comes back with or without regain in 33%.

However, with DS.... regain or no regain it's a "cure" 98.9% of the time.

This is why DS is being tested in Europe on normal size BMI folks with out of control diabetes. Insulin is no longer effective for this population.

Stem Cell therapy is also proving to be an amazing thing for Type I and Type II diabetics. Within a couple of months of the first treatment many Type I diabetics have a drastically lower dose of insulin and with a 2nd treatment many are off all medications completely for diabetes. For the first time since childhood these people are off insulin completely.

There are a couple of downsides to stem cell treatments. Much research still needs to be done. If someone has any tumors (cancer) existing the stem cells will go to the tumors instead of the pancreas and help the tumors grow like crazy. Also, stem cells only last about 2 years or so for diabetes and must be repeated. But stem cell therapy is the only known treatment for pancreatic disease causing diabetes and DS is the only known cure for Type II.

Studies Weigh in on Safety and Effectiveness of Newer Bariatric and Metabolic Surgery Procedure

Published June 2012

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SAN DIEGO, CA – JUNE 20, 2012 – Studies from Stanford University, Cleveland Clinic Florida and the Naval Medical Center in San Diego show laparoscopic sleeve gastrectomy, an increasingly popular surgical procedure where the stomach is reduced by 85 percent, is as safe as or safer than laparoscopic gastric bypass or gastric banding. The studies* were presented here at the 29th Annual Meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS).

In one study, Stanford University researchers analyzed safety data from nearly 270,000 metabolic and bariatric surgeries performed between 2007 and 2010. Nearly 16,000 of the procedures were sleeve gastrectomies, which had a 30-day serious complication rate of less than one percent (0.96%), compared to a rate of 1.25 percent for gastric bypass and one-quarter of one percent (0.25%) for gastric banding.

The 30-day mortality rate for sleeve gastrectomy was 0.08 percent, while the rate for gastric bypass was 0.14 percent and 0.03 percent for gastric banding. These mortality and complication rates are lower than those typically associated with gallbladder or hip replacement surgery.

Gastric bypass resulted in the most average weight loss after one year. The average body mass index (BMI) after this procedure dropped by about 40 percent (47.7 to 31.2). Sleeve gastrectomy patients experienced about a 30 percent drop (47.5 to 34.1), while gastric band patients had a 20 percent reduction (45.1 to 37.5).

“In terms of risk and benefit, sleeve gastrectomy sits nicely between gastric bypass and adjustable gastric band,” said lead study author John Morton, MD, Associate Professor of Surgery and Director of Bariatric Surgery at Stanford Hospital & Clinics at Stanford University.

This data, along with several other large studies published within the last two years, was recently submitted to the Centers for Medicare & Medicaid Services (CMS), as the agency considers a new national coverage determination for laparoscopic sleeve gastrectomy for its beneficiaries.

Researchers from Cleveland Clinic Florida reviewed safety outcomes of more than 2,400 of their patients who had sleeve gastrectomy, gastric bypass or bariatric and metabolic surgery between 2005 and 2011. This study found sleeve gastrectomy had the lowest complication and reoperation rates of the three procedures.

The rate of a gastrointestinal leak, considered a serious complication, was three-tenths of one percent (0.3%) for sleeve gastrectomy versus four-tenths of one percent (0.4%) for gastric bypass patients. The percentage of procedures requiring reoperations due to complications was 15.3 percent for the gastric band, 7.7 percent for gastric bypass and 1.5 percent for sleeve gastrectomy. On average, patients had a BMI between 44 and 48, were 46 years of age and had at least two obesity-related conditions, such as Type 2 diabetes and high blood pressure.

A third study on sleeve gastrectomy conducted by the Naval Medical Center in San Diego found while gastric bypass patients lost more of their excess weight after the first year, 72.3 percent versus 63.7 percent, there were no statistically significant differences in excess weight loss after two and five years. This study examined 486 patients, half had gastric bypass and half had sleeve gastrectomy.

“Sleeve gastrectomy has proven itself to be a safe and effective option in patients with morbid obesity and this procedure should be considered a primary procedure for weight loss and obesity-related disease improvement and resolution,” said Robin Blackstone, MD, President ASMBS.

About Obesity and Metabolic and Bariatric Surgery

Obesity is one of the greatest public health and economic threats facing the United States. Approximately 72 million Americans are obese[4] and, according to the ASMBS, about 18 million have morbid obesity. Obese individuals with a BMI greater than 30 have a 50 to 100 percent increased risk of premature death compared to healthy weight individuals as well as an increased risk of developing more than 40 obesity-related diseases and conditions including Type 2 diabetes, heart disease and cancer. The federal government estimated that in 2008, annual obesity-related health spending reached $147 billion, double what it was a decade ago, and projects spending to rise to $344 billion each year by 2018.

Metabolic/bariatric surgery has been shown to be the most effective and long lasting treatment for morbid obesity and many related conditions and results in significant weight loss. In the United States, about 200,000 adults have metabolic/bariatric surgery each year. The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of metabolic/bariatric surgery due in large part to improved laparoscopic techniques. The risk of death is about 0.1 percent and the overall likelihood of major complications is about 4 percent.

About the ASMBS

            The ASMBS is the largest organization for bariatric surgeons in the world. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of morbid obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for morbidly obese patients. For more information, visit www.asmbs.org.

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*PL-102: Laparoscopic Gastric Bypass Versus Laparoscopic Vertical Gastrectomy for Morbid Obesity:

5 Year Results in A Military Institution

Dr. Gordon Wisbach; David M. Lim, DO; William Bertucci, MD; Janos Taller, MD; Robert H. Riffenburgh, PhD, MD; Jack O’Leary, RN 

*PL-104: National Comparisons of Bariatric Surgery Safety And Efficacy: Findings from the BOLD Database 2007-2010

Dr. John Morton; Bintu Sherif, Deborah Winegar, PhD; Ninh Nguyen MD, FASMBS; Jaime Ponce, MD, FASMBS; Robin Blackstone, MD, FASMBS

*PL-133: Procedure Related Morbidity Comparing Roux-en-Y Gastric Bypass, Sleeve Gastrectomy And Laparoscopic Adjustable Gastric Band: A Retrospective Long Term Follow Up

Dr. Raul J. Rosenthal; Abraham Fridman, DO; Karan Bath, MD; Andre Teixeira, MD; Samuel Szomstein, MD, FASMBS

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[7]Finkelstein, E. A., Trogdon, J. G., Cohen, J. W., et al. (2009). Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Affairs. 28(5) pp. w822-w831. Accessed February 2012 fromhttp://www.cdc.gov/obesity/causes/economics.html

[8]Thorpe, K (2009). The future costs of obesity: national and state estimates of the impact of obesity on direct health care expenses. America’s Health Rankings. Accessed June 2012 fromhttp://www.fightchronicdisease.org/sites/fightchronicdisease.org/files/docs/CostofObesityReport-FINAL.pdf

[9]Weiner, R. A. (2010). Indications and principles of metabolic surgery. U.S. National Library of Medicine. 81(4) pp.379-394.

[10]Chikunguw, S., Patricia, W., Dodson, J. G., et al. (2009). Durable resolution of diabetes after roux-en-y gastric bypass associated with maintenance of weight loss. Surgery for Obesity and Related Diseases. 5(3) p. S1

[11]Torquati, A., Wright, K., Melvin, W., et al. (2007). Effect of gastric bypass operation on framingham and actual risk of cardiovascular events in class II to III obesity. Journal of the American College of Surgeons. 204(5) pp. 776-782. Accessed March 2012 from http://www.ncbi.nlm.nih.gov/pubmed/17481482

[12]American Society for Metabolic & Bariatric Surgery. (2009). All estimates are based on surveys with ASMBS membership and bariatric surgery industry reports.

[13]Poirier, P., Cornier, M. A., Mazzone, T., et al. (2011). Bariatric surgery and cardiovascular risk factors. Circulation: Journal of the American Heart Association. 123 pp. 1-19. Accessed March 2012 from http://circ.ahajournals.org/content/123/15/1683.full.pdf

[14]Agency for Healthcare Research and Quality (AHRQ). Statistical Brief #23. Bariatric Surgery Utilization and Outcomes in 1998 and 2004. Jan. 2007.

[15]Flum, D. R. et al. (2009). Perioperative safety in the longitudinal assessment of bariatric surgery. New England Journal of Medicine. 361 pp.445-454. Accessed June 2012 from http://content.nejm.org/cgi/content/full/361/5/445

https://asmbs.org/resources/studies-weigh-in-on-safety-and-effectiveness-of-newer-bariatric-and-metabolic-surgery-procedure