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Issue 180 Item 1 Gastric Bypass Urged for Very Obese Diabetics

Researchers recommend that stomach bypass surgery should become “standard treatment” for morbidly obese patients with type 2 diabetes, because the majority achieve excellent glucose control following the procedure.

In the Annals of Surgery, Dr. Philip R. Schauer, at the University of Pittsburgh, and others describe the outcomes of 191 such patients who underwent "keyhole" surgery to bypass a large part of the stomach. The procedure drastically reduces the absorption of food.

Within days after surgery, about one third of the patients no longer required anti-diabetes medication.
Among the 119 subjects who had diabetes for 5 years or less, the disease completely resolved in 95 percent, with no recurrences during an average 20 months of follow-up.

For the entire group, average weight decreased from 308 to 211 pounds. Prior to surgery, 65 percent required oral anti-diabetes medication and 27 percent required insulin. Afterward, those figures dropped to 13 percent and 6 percent.

Also, many patients reported that diabetes-related nerve damage or erectile dysfunction had improved.
The surgery is not without risks. Some 13 percent of patients experienced problems, consisting primarily of pneumonia, small bowel obstruction or blood clots. There was one death within the first month after surgery.
Nonetheless, Schauer’s group says, "Unequivocally, surgery is superior to medical management of type 2 diabetes" in very obese patients.

They recommend that gastric bypass in this situation should be performed early in the course of the disease before permanent damage has occurred. Annals of Surgery, October 2003.

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FACT: Apolipoprotein B (apoB) appears to represent a better index of risk than does low-density lipoprotein cholesterol (LDLC) level, investigators report in the November 11th issue of Circulation: Journal of the American Heart Association. "Our study showed that patients who had a high triglyceride level and a high apoB were the ones more likely to have high blood sugar, more insulin resistance, more inflammation, and more prothrombogenic factors," co-author Dr. Allan D. Sniderman.

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