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Weight-loss surgery may reverse diabetes

Bariatric weight-loss surgery may free diabetics from the need for daily insulin injections and medications a few years after undergoing the procedure, according to a new study conducted by the Cleveland Clinic.

The STAMPEDE (Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently) study, published in the New England Journal of Medicine, enrolled 150 patients, and is the largest randomized trial published that examines the efficacy of various interventions available for obese and diabetic patients. Overall, more than 90 percent of patients who received bariatric surgery were able to lose 25 percent of their body weight.

"Initially we thought diabetes was a disease you could not reverse or end. We do realize now that there may be a treatment that could end diabetes for some people and that's exciting," Dr. Sangeeta Kashyap, one of the study's lead investigators, told Reuters.

For the study, which was also presented at the Annual Scientific Session of the American College of Cardiology in Washington, D.C., a third of patients underwent gastric bypass surgery with medications. Gastric bypass is a surgical procedure that shrinks the size of the stomach into a small pouch by stapling a section of the stomach. Another third of patients in the study had a sleeve gastrectomy, a partial removal of the stomach, and then took medications. The remaining third received only medications and psychological counseling.

The researchers found after three years, 37.5 percent of patients who had gastric bypass surgery were able to stabilize their blood sugar to healthy levels without medication.

By contrast, 24.5 percent of patients who underwent the sleeve gastectomy were able to control their blood sugar without medications, while just five percent of patients who received only medication and counseling were able to successfully control their diabetes.

Study participants who underwent bariatric surgery were also able to reduce their doses of blood pressure and cholesterol medications. Overall, the bariatric patients needed less medication for chronic health conditions associated with obesity. Only five to 10 percent of bariatric patients needed cardiovascular and glucose lowering medication, compared with 55 percent who only received medication and counseling.

Additionally, bariatric surgery patients also showed improved kidney function. The researchers measured albumin levels in urine, a protein byproduct that often is elevated in people with type 2 diabetes and indicates kidney damage. They found patients who underwent surgery three years prior had lower albumin levels compared with patients who were only on medication.

This study is not the first to find bariatric surgery may help reverse diabetes in obese patients. Another Cleveland Clinic study, published in September, found 80 percent of patients who had the surgeries met target blood sugar levels of 7 percent HbA1c, a level recommended by the American Diabetes Association. And a study published in the Journal of the American Medical Association found gastric bypass surgery was more effective for managing mild to moderate diabetes and obesity than medication alone.

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