EDITORIAL: Alternative Surgery

Jan 28, 05:56 AM

Jan. 28--The possibility that diabetes can be cured, not merely managed for a lifetime, received a boost last week. Australian researchers published a study in which they found weight-loss surgery to be more effective than the conventional methods of treating Type 2 diabetes in obese patients.

An editorial accompanying the study, which appeared in the Journal of the American Medical Association, observed that the knowledge accumulating from research into surgical treatment for diabetes "may be the most profound since the discovery of insulin." If the observation is accurate, the prospect of a surgical remedy amounts to a breakthrough in treating a costly chronic disease.

An estimated 19 million Americans have Type 2 diabetes, which is generally associated with obesity. The rate is growing at 8 percent a year. An additional 54 million people have elevated blood sugar levels that raise their risk of developing the diabetes. More alarming yet, as obesity rates rise across the population, the incidence of the disease, typically evident in adulthood, is rising among children and teenagers. The health complications and the economic impact are burdensome. According to the American Diabetes Association, the disease is costing the nation $174 billion a year in medical care and lost productivity.

The Australian study compared two treatment approaches in 60 obese patients with Type 2 diabetes. One treatment was gastric banding, a surgical procedure that uses a band to reduce the size of the stomach (and how much patients can eat). The other relied on conventional treatments, involving diet, exercise, medications and counseling.

According to the study, the patients who had the surgery lost much more of their body weight -- 20.7 percent compared to 1.7 percent with conventional treatment. Remarkably, 73 percent of the surgical patients showed no signs of diabetes. In contrast, signs of diabetes were in remission in a mere 13 percent of patients under conventional treatment.

The importance of the findings will be immediately evident to anyone whose health depends on losing weight -- and keeping it off permanently -- but who has faced a demoralizing struggle to shed the excess pounds. The possibility to reverse Type 2 diabetes through gastric banding, a less invasive procedure than other weight-loss surgeries, promises a safe and effective alternative for patients.

Still, optimism about the potential of surgical treatment as a cure for Type 2 diabetes must remain tempered. Impressive as the findings are, the study involved a tiny sample of 60 patients who had recent and relatively mild forms of the disease. It is unclear what the lasting effects would be. As the obesity rate continues to rise, the protection remains a healthy diet and exercise to control weight gain.

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