Finding Balance through Innovation

Top 10 Innovations for 2013

#1 Bariatric Surgery for Control of Diabetes

The pancreas normally makes enough insulin to keep the supply and use of glucose in the body in balance. Glucose is used by cells for energy, but when the delicate glucose balancing system is disrupted—most often because of obesity—Type 2 diabetes develops.

In the United States, the number of diabetes cases has tripled in the past 30 years to more than 20 million, according to the Centers for Disease Control and Prevention, and more than 90 percent of these people have Type 2 diabetes. As a person's weight increases, so does the risk and severity of this ailment. About 40% of people with Type 2 diabetes need daily insulin injections to maintain safe levels of glucose. 70 percent of adults in the United States are either overweight or obese, and so are one third of children and teens. Exercise and diet alone are not effective for treating severe obesity or the Type 2 diabetes that develops. Once a person reaches 100 pounds or more above his or her ideal weight, losing the weight and keeping it off for many years almost never happens.

While the medications we have for diabetes are good, about half of the people who take them are not able to control their disease. This can often lead to heart attack, blindness, stroke, and kidney failure.

Surgery for obesity, often called bariatric surgery, shrinks the stomach into a small pouch and rearranges the digestive tract so that food enters the small intestine at a later point than usual.

Over the years, many doctors performing weight-loss operations found that the surgical procedure would rid patients of Type 2 diabetes, oftentimes before the patient left the hospital.

To explore this diabetes treatment hypothesis, 150 patients with Type 2 diabetes and obesity were enrolled in a study in 2007. 50 patients had gastric bypass surgery, a procedure that reduces stomach volume from the size of an inflated football to golf ball size; 50 had a sleeve gastrectomy surgery, which reduces the stomach from the size of a football to that of a banana; and 50 were offered counseling in nutrition and exercise while they continued taking their diabetes medication.

By closing off most of the stomach to food, people who received bariatric surgery ate less and, therefore, lost weight. Patients in the study lost about five times as much weight on average as those only taking bloodsugar- lowering medications.

The study results, published in the New England Journal of Medicine in 2012, astounded the medical world. Compared with patients taking diabetes medication and receiving lifestyle counseling, those who had bariatric surgery were far more likely to be free of diabetes or to have reduced their dependence on diabetes medications for at least two years. The weight-loss surgery also helped many to lower their blood pressure and cholesterol. Most of the patients went from a dozen or more medications daily to none or just a few. A cure for Type 2 diabetes? Perhaps. Larger randomized trials will eventually determine this. In the meantime, many diabetes experts now believe that weight-loss surgery should be offered much earlier as a reasonable treatment option for patients with poorly controlled diabetes—and not as a last resort.