Diabetes, Heart, and Cardiovascular Diseases News Chronicle.
Article 331   Published on June 27, 2018

Know how to lower body weight and fat.

Gastric Bypass Surgery (RYGB) Can Give A Better Control Of Type 2 Diabetes And Obesity


Even though it is possible to lower the body weight and high blood sugar (glucose) levels by participating in an intensive lifestyle modification program, it is difficult to stick to these measures for a longer period. The following options are available for a severely obese patient with a poorly controlled diabetes to lower the blood sugar (glucose) levels.

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  • Participating in an intensive lifestyle modification program such as a regular exercise, eating healthy foods with a low glycemic index, by lowering the daily calorie intake, by avoiding alcohol consumption/smoking and by reducing stress.
  • Undergoing a gastric bypass surgery for a quick weight loss as the obesity is linked to the high blood sugar (glucose) levels.

Gastric bypass surgery (RYGB) can give a better control of type 2 diabetes, obesity than lifestyle modification.

The current guidelines suggest a Bariatric surgery for a weight loss for a patient with a body mass index (BMI) of over 40 kg/m2 or for patient with an obesity-associated diseases such as type 2 diabetes (T2D) with a body mass index (BMI) over 35 kg/m2.

An earlier study shows a reversal of type 2 diabetes with a Bariatric surgery in an obese patient having a high blood sugar (glucose) levels. But some healthcare professionals hesitate to recommend a Bariatric surgery to a mild overweight to the morbidly obese patient with type 2 diabetes.

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But this trial shows patients with an uncontrolled (or a poorly controlled) blood glucose levels and with mild obesity can be benefited from the Bariatric surgery.

A three year randomized controlled trial SLIMM-T2D (Surgery or Lifestyle with Intensive Medical Management in the Treatment of Type 2 Diabetes) study has found that a 58 percent of the patients who underwent a bypass surgery called Roux-en-Y gastric bypass (RYGB) surgery has achieved better A1C levels of less than seven percent when compared to a 11 percent of patients who underwent the Weight Achievement and Intensive Treatment (Why WAIT) program from the Joslin Diabetes Center. Other improvements are.

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  • A reduction in the risk of cardiovascular disease.
  • An improvement in the obesity-related quality of life.
Researchers from both Joslin Diabetes Center and Brigham and Women's Hospital have conducted this study.

Researchers have conducted a randomized study on 38 obese patients with type 2 diabetes (15 men and 23 women), aged between 46 and 58 years with a body mass index between 33 kg/m2 and 44 kg/m2. Researchers have randomly selected 19 patients to the laparoscopic Roux-en-Y gastric bypass (RYGB) surgery and the remaining patients to the Intensive Medical Diabetes and Weight Management (IMWM).

The patients under the Medical Diabetes And Weight Management Program have participated in the exercise programs, changed the diet, took treatments (medications, pills or tablets) to increase the weight loss and participated in the educational classes. All of them are with high blood sugar levels (HbA1c levels between 7.2 and 9.8). Researchers assessed the following health parameters.

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  • A change in body weight.
  • A change in the blood sugar levels (HbA1c).
  • A change in cardiovascular risk factors.
  • A self-reported health status of each participant (36-Item Short-Form survey. SF-36).

Researchers used the following tools in the study

  • The "Problem Areas in Diabetes" (PAID) instrument to determine the emotional distress in a patient.
  • The "Assessing the Impact of Weight on Quality of Life in Adults" (IWQOL) instrument.
  • The UKPDS (United Kingdom Prospective Diabetes Study) risk engine calculator. This tool can provide the risk of heart diseases such as coronary heart disease and stroke in a patient with type 2 diabetes.

The study shows the following.

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Health event Result
Weight loss In the patients under the IMWM group, researchers have observed a good weight loss and a lower blood sugar (glucose) levels during the initial stage, but there was no improvement over time. Less than ten percent of the patients have achieved a weight loss with the lifestyle modifications. The patients under the bypass surgery have lost 55 pounds (lbs) of weight on an average when compared to just 11 pounds (lbs) on an average in the patients under the IMWM group.

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Health event Result
Blood sugar (glucose) levels Patients under the bypass surgery have reduced the HbA1c levels by 1.79 percent compared to just 0.39 percent in the patients under the IMWM group.

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Health event Result
IWQOL score There was a greater improvement in IWQOL score in the bypass surgery group (surgical group). The improvement was due to the subscales of the physical function, work performance, and self-esteem. The study has found that the improvement in the overall quality of life was strongly linked with the body weight loss compared with HbA1c levels.

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Health event Result
PAID score and SF-36 There was an improvement in the 36-Item Short-Form survey (SF-36) and the PAID score in the patients of both the IMWM and the bypass surgery groups. The study has found no difference between the treatments.

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Health event Result
Reduction in the risk of cardiovascular health In the bypass surgery group, researchers have observed a marked reduction in cardiometabolic and cardiovascular risk. This trial has found a reduction in risk factors for the coronary heart disease and stroke such as blood pressure (hypertension. BP), triglycerides (high fat in the blood), low HDL (GOOD) cholesterol, high LDL (BAD) cholesterol and use of insulin in the body (insulin resistance).

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Health event Result
Other benefits After the bypass surgery, the patients used lower medication (treatments, drugs or pills) to control the blood cholesterol levels, blood sugar levels, and blood pressure.

This study shows even for a mild to a moderately obese patient with type 2 diabetes, the gastric bypass surgery can help in achieving sustained weight loss, lowers the risk of cardiovascular disease and HbA1c levels (improved diabetes management) compared with Medical Diabetes And Weight Management program. Medical diabetes and weight management program includes lifestyle modifications such as eating healthy foods with a low glycemic index, a regular exercise, avoiding alcohol/smoking and reducing stress.

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Lead author of the study was Donald C. Simonson, MD, MPH, ScD, Lecturer in Medicine, Brigham and Women's Hospital, Boston, United States. Co-authors of the study were Allison B. Goldfine, Ashley Vernon, Florencia Halperin and Kathleen Foster. The study was published February 2018, in the Diabetes Care. Title of the article was "Clinical and Patient-Centered Outcomes in Obese Patients With Type 2 Diabetes 3 Years After Randomization to Roux-en-Y Gastric Bypass Surgery Versus Intensive Lifestyle Management: The SLIMM-T2D Study."
DOI: doi.org/10.2337/dc17-0487

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