WASHINGTON -- New research is boosting hopes that weight-loss surgery can put some patients' diabetes into remission for years and perhaps, in some cases, for good.
Doctors on Monday gave longer results from a landmark study showing that stomach-reducing operations are better than medications for treating "diabesity," the deadly duo of obesity and Type 2 diabetes. Millions of Americans have this and can't make enough insulin or use what they do make to process food.
Many experts were skeptical that the benefits seen after a year would last. Now, three-year results show an even greater advantage for surgery.
Blood-sugar levels were normal in 38 percent and 25 percent of two groups given surgery, but in only 5 percent of those treated with medications.
The results are "quite remarkable" and could revolutionize care, said one independent expert, cardiologist Robert Siegel at Los Angeles' Cedars-Sinai Medical Center. "No one dreamed, at least I didn't," that obesity surgery could have such broad effects long before it caused patients to lose weight, he said. Some patients were able to stop using insulin a few days after surgery.
At three years, "more than 90 percent of the surgical patients required no insulin," and nearly half of them had needed it at the start of the study, said its leader, Philip Schauer of the Cleveland Clinic. In contrast, insulin use rose in the medication group, from 52 percent at the start to 55 percent at three years.
The results, reported Monday at an American College of Cardiology conference in Washington, were published online by the New England Journal of Medicine.
Some patients, such as Heather Britton, 55, a suburban Cleveland computer programmer, have passed the five-year mark when some experts consider cure or prolonged remission a possibility. Before the study, she was taking drugs for diabetes, high blood pressure and high cholesterol; she takes none now. "It's a miracle; it saved my life," she said. The disease killed her mother and grandmothers at a young age.
About 26 million Americans have diabetes, and two-thirds of them are overweight or obese. Diabetes is a leading cause of heart disease, strokes, kidney failure, eye trouble and other problems. It's treated with various drugs and insulin, and doctors urge weight loss and exercise, but few people can drop enough pounds to make a difference.
Bariatric surgery now is mainly a last resort for the very obese who have failed less drastic ways to lose weight. It costs $15,000 to $25,000, and Medicare covers it for very obese diabetics. Gastric bypass is the most common type: Through "keyhole" surgery, doctors reduce the stomach to a small pouch and reconnect it to the small intestine. Another type is sleeve gastrectomy, reducing the stomach's size less drastically.
Dr. Schauer's study tested these two operations versus medication alone in 150 mildly obese people with severe diabetes. Their A1c levels, a key blood-sugar measure, were over 9 on average at the start. A healthy A1c is 6 or below, and the study aimed for that, even though the American Diabetes Association sets an easier target of 7.
After three years, researchers had follow-up on 91 percent of the original 150 patients. The medication group's A1c averaged 8.4; the surgery groups were at 6.7 and 7, with gastric bypass being a little better. The surgery groups also shed more pounds -- 25 percent and 21 percent of their body weight versus 4 percent for the medication group.
Doctors don't know how surgery produces these benefits, but food makes the gut produce hormones to spur insulin, and trimming away part of it affects many hormones and metabolism.
An obesity surgery equipment firm sponsored the study, and some researchers are paid consultants. The federal government also gave grant support.